Provider Demographics
NPI:1912902347
Name:KITSAP PHYSICAL THERAPY AND SPORTS CLINIC PS INC
Entity Type:Organization
Organization Name:KITSAP PHYSICAL THERAPY AND SPORTS CLINIC PS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HRD
Authorized Official - Prefix:
Authorized Official - First Name:SUMMER
Authorized Official - Middle Name:
Authorized Official - Last Name:ZUMWALT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-598-3764
Mailing Address - Street 1:2400 NW MYHRE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-7672
Mailing Address - Country:US
Mailing Address - Phone:360-598-3764
Mailing Address - Fax:360-598-3282
Practice Address - Street 1:2400 NW MYHRE RD STE 101
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-7672
Practice Address - Country:US
Practice Address - Phone:360-598-3764
Practice Address - Fax:360-598-3282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-13
Last Update Date:2021-05-10
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
WAGAB06820Medicare PIN