Provider Demographics
NPI:1477147619
Name:SEATTLE SPORT REHABILITATION AND PERFORMANCE
Entity Type:Organization
Organization Name:SEATTLE SPORT REHABILITATION AND PERFORMANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:AGLUBAT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:808-348-9109
Mailing Address - Street 1:5526 35TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-2312
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1500 WESTLAKE AVE N STE 106
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-3036
Practice Address - Country:US
Practice Address - Phone:206-268-0696
Practice Address - Fax:206-787-9086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-28
Last Update Date:2021-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy