Provider Demographics
NPI:1841388618
Name:PEAK SPORTS & SPINE PHYSICAL THERAPY-RENTON, P.S.
Entity Type:Organization
Organization Name:PEAK SPORTS & SPINE PHYSICAL THERAPY-RENTON, P.S.
Other - Org Name:GIL SCHOOS RENTON, P.S.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:KOWALINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, SCS
Authorized Official - Phone:425-235-9505
Mailing Address - Street 1:451 DUVALL AVE NE
Mailing Address - Street 2:SUITE #200
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059
Mailing Address - Country:US
Mailing Address - Phone:425-235-9505
Mailing Address - Fax:425-226-7334
Practice Address - Street 1:451 DUVALL AVE NE
Practice Address - Street 2:SUITE 200
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98059-4675
Practice Address - Country:US
Practice Address - Phone:425-235-9505
Practice Address - Fax:425-226-7334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB27458Medicare ID - Type UnspecifiedMEDICARE GROUP #