| Organization Name: | KENT PHYSICAL THERAPY & SPORTS PERFORMANCE CENTER LLC |
| NPI Number: | 1013107549 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LANCE M. MILLER (OWNER/PHYSICAL THERAPIST) |
| Mailing Address: | 2205 Wall St Everett |
| State: | WA US |
| Postal Code: | 982013761 |
| Phone Number: | 4255128695 |
| Fax Number: | 4255128697 |
| NPI Enumeration Date: | 07/31/2007 |
| NPI Last Update Date: | 08/07/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | PT00008062 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |