1003993890 NPI number — REHABILITATION, SPORTS & SPINE CENTER, P.S.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003993890 NPI number — REHABILITATION, SPORTS & SPINE CENTER, P.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REHABILITATION, SPORTS & SPINE CENTER, P.S.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003993890
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3216 NORTON AVE
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
EVERETT
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98201-4290
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-258-7511
Provider Business Mailing Address Fax Number:
425-258-7742

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3216 NORTON AVE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
EVERETT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98201-4290
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-258-7511
Provider Business Practice Location Address Fax Number:
425-258-7742
Provider Enumeration Date:
11/01/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BATIE
Authorized Official First Name:
KATHY
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
425-258-7511

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7086598 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 165669 . This is a "LABOR & INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".