Provider Demographics
NPI:1740723915
Name:PREVAIL PRACTICES, PLLC
Entity type:Organization
Organization Name:PREVAIL PRACTICES, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:BRUK
Authorized Official - Last Name:BALLENGER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, PT
Authorized Official - Phone:206-920-5372
Mailing Address - Street 1:18303 1ST AVE NE
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-3529
Mailing Address - Country:US
Mailing Address - Phone:206-920-5372
Mailing Address - Fax:
Practice Address - Street 1:18303 1ST AVE NE
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98155-3529
Practice Address - Country:US
Practice Address - Phone:206-920-5372
Practice Address - Fax:866-329-2785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA7473225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty