Provider Demographics
NPI:1003993890
Name:REHABILITATION, SPORTS & SPINE CENTER, P.S.
Entity Type:Organization
Organization Name:REHABILITATION, SPORTS & SPINE CENTER, P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:BATIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-258-7511
Mailing Address - Street 1:3216 NORTON AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-4290
Mailing Address - Country:US
Mailing Address - Phone:425-258-7511
Mailing Address - Fax:425-258-7742
Practice Address - Street 1:3216 NORTON AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4290
Practice Address - Country:US
Practice Address - Phone:425-258-7511
Practice Address - Fax:425-258-7742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7086598Medicaid
WA165669OtherLABOR & INDUSTRIES
WA165669OtherLABOR & INDUSTRIES