Provider Demographics
NPI:1699713370
Name:EVERETT PHYSICAL THERAPY AND SPORT PERFORMANCE CENTER PLLC
Entity type:Organization
Organization Name:EVERETT PHYSICAL THERAPY AND SPORT PERFORMANCE CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BINSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-297-7052
Mailing Address - Street 1:2000 HEWITT AVE STE 115
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-3600
Mailing Address - Country:US
Mailing Address - Phone:425-252-3908
Mailing Address - Fax:
Practice Address - Street 1:2000 HEWITT AVE
Practice Address - Street 2:#115
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201
Practice Address - Country:US
Practice Address - Phone:425-252-3908
Practice Address - Fax:425-252-7940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4702EVOtherREGENCE BLUESHIELD GRP #
WA8931865OtherL&I CRIME VICTIMS
WA9054974Medicaid
WA2029657-00OtherOWCP
WA7121858Medicaid
WA0179003OtherDEPT. OF LABOR & INDUSTRY
WA9054974Medicaid