1285924787 NPI number — SESE SPORTS PERFORMANCE GROUP, PS

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 1285924787 NPI number — SESE SPORTS PERFORMANCE GROUP, PS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SESE SPORTS PERFORMANCE GROUP, PS
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:
NORTHWEST SPORTS PERFORMANCE & WELLNESS
Provider Other Organization Name Type Code:
3
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:
1285924787
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10351 NE 10TH ST APT 907
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLEVUE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98004-4645
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-221-7253
Provider Business Mailing Address Fax Number:
888-812-4162

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1603 116TH AVE NE
Provider Second Line Business Practice Location Address:
111
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98004-3009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-221-7253
Provider Business Practice Location Address Fax Number:
888-812-4162
Provider Enumeration Date:
04/18/2011

Additional Information

Authorized Official

Authorized Official Last Name:
SESE
Authorized Official First Name:
HARRY
Authorized Official Middle Name:
GABRIEL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
425-221-7253

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2255A2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225700000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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