Provider Demographics
NPI:1154655215
Name:PEAK SPORTS & SPINE PHYSICAL THERAPY-KLAHANIE PS
Entity Type:Organization
Organization Name:PEAK SPORTS & SPINE PHYSICAL THERAPY-KLAHANIE PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCHOOS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:425-462-4330
Mailing Address - Street 1:4550 KLAHANIE DR SE
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98029-5812
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4550 KLAHANIE DR SE
Practice Address - Street 2:
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98029-5812
Practice Address - Country:US
Practice Address - Phone:425-391-2427
Practice Address - Fax:425-392-4098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-22
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602931273261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy