Provider Demographics
NPI:1285924787
Name:SESE SPORTS PERFORMANCE GROUP, PS
Entity type:Organization
Organization Name:SESE SPORTS PERFORMANCE GROUP, PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:GABRIEL
Authorized Official - Last Name:SESE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-221-7253
Mailing Address - Street 1:10351 NE 10TH ST APT 907
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-4645
Mailing Address - Country:US
Mailing Address - Phone:425-221-7253
Mailing Address - Fax:888-812-4162
Practice Address - Street 1:1603 116TH AVE NE
Practice Address - Street 2:111
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3009
Practice Address - Country:US
Practice Address - Phone:425-221-7253
Practice Address - Fax:888-812-4162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-18
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty