Provider Demographics
NPI:1588280804
Name:RAINIER FAMILY AND SPORTS MEDICINE P C
Entity type:Organization
Organization Name:RAINIER FAMILY AND SPORTS MEDICINE P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENT
Authorized Official - Middle Name:R
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:253-987-7754
Mailing Address - Street 1:1402 LAKE TAPPS PKWY SE
Mailing Address - Street 2:STE F104 #133
Mailing Address - City:SUMNER
Mailing Address - State:WA
Mailing Address - Zip Code:98390
Mailing Address - Country:US
Mailing Address - Phone:253-987-7754
Mailing Address - Fax:253-987-7049
Practice Address - Street 1:16202 64TH ST E STE 104
Practice Address - Street 2:
Practice Address - City:SUMNER
Practice Address - State:WA
Practice Address - Zip Code:98390-3028
Practice Address - Country:US
Practice Address - Phone:253-987-7754
Practice Address - Fax:253-987-7049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-23
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty