Provider Demographics
NPI:1003272675
Name:EVERETT PHYSICAL THERAPY AND SPORT PERFORMANCE CENTER PLLC
Entity Type:Organization
Organization Name:EVERETT PHYSICAL THERAPY AND SPORT PERFORMANCE CENTER PLLC
Other - Org Name:SPORTS PHYSICAL THERAPY KIRKLAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BINSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-297-7000
Mailing Address - Street 1:10600 NE 68TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-7044
Mailing Address - Country:US
Mailing Address - Phone:425-823-1389
Mailing Address - Fax:425-820-3996
Practice Address - Street 1:10600 NE 68TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-7044
Practice Address - Country:US
Practice Address - Phone:425-823-1389
Practice Address - Fax:425-820-3996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-12
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty