Provider Demographics
NPI:1114552155
Name:PRO SPORT PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:PRO SPORT PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SPAULDING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:253-853-4000
Mailing Address - Street 1:5125 OLYMPIC DR STE 110
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1712
Mailing Address - Country:US
Mailing Address - Phone:253-853-4000
Mailing Address - Fax:253-853-4001
Practice Address - Street 1:5125 OLYMPIC DR STE 110
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1712
Practice Address - Country:US
Practice Address - Phone:253-853-4000
Practice Address - Fax:253-853-4001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty