Provider Demographics
NPI:1619533932
Name:SAMMAMISH PHYSICAL THERAPY AND SPORTS REHAB PLLC
Entity Type:Organization
Organization Name:SAMMAMISH PHYSICAL THERAPY AND SPORTS REHAB PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARSCALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:949-836-8710
Mailing Address - Street 1:22840 NE 8TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98074-7263
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22840 NE 8TH ST STE 102
Practice Address - Street 2:
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98074-7263
Practice Address - Country:US
Practice Address - Phone:425-898-8540
Practice Address - Fax:425-898-1570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-13
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy