Provider Demographics
NPI:1396150835
Name:SOUND BALANCE PHYSICAL THERAPY
Entity type:Organization
Organization Name:SOUND BALANCE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:SCHETSELAAR
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:253-217-0832
Mailing Address - Street 1:15719 63RD STREET CT E
Mailing Address - Street 2:#1
Mailing Address - City:SUMNER
Mailing Address - State:WA
Mailing Address - Zip Code:98390-3067
Mailing Address - Country:US
Mailing Address - Phone:253-217-0832
Mailing Address - Fax:
Practice Address - Street 1:15719 63RD STREET CT E
Practice Address - Street 2:#1
Practice Address - City:SUMNER
Practice Address - State:WA
Practice Address - Zip Code:98390-3067
Practice Address - Country:US
Practice Address - Phone:253-217-0832
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60391158261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy