Provider Demographics
NPI:1902018054
Name:PIONEER SPORTS AND PHYSICAL THERAPY
Entity Type:Organization
Organization Name:PIONEER SPORTS AND PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEFFMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:206-264-9780
Mailing Address - Street 1:506 SECOND AVENUE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104
Mailing Address - Country:US
Mailing Address - Phone:206-264-9780
Mailing Address - Fax:
Practice Address - Street 1:506 SECOND AVENUE
Practice Address - Street 2:SUITE 100
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104
Practice Address - Country:US
Practice Address - Phone:206-264-9780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA142436OtherWASHINGTON LABOR & INDUST
WA4614402OtherAETNA PROVIDER NUMBER
WA8935255OtherCRIME VICTIMS COMPENSATIO
WA7113897Medicaid
WA5268LEOtherREGENCE BCBS NUMBER
WA7113897Medicaid