Provider Demographics
NPI:1114073194
Name:SPORTS REACTION CENTER INC
Entity Type:Organization
Organization Name:SPORTS REACTION CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHASAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:425-643-9778
Mailing Address - Street 1:1750 112TH AVE NE
Mailing Address - Street 2:SUITE D-154
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3752
Mailing Address - Country:US
Mailing Address - Phone:425-643-9778
Mailing Address - Fax:425-643-6448
Practice Address - Street 1:1750 112TH AVE NE
Practice Address - Street 2:SUITE D-154
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3752
Practice Address - Country:US
Practice Address - Phone:425-643-9778
Practice Address - Fax:425-643-6448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00002855174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1649232588OtherINDIVIDUAL UPN