| Organization Name: | PINE LAKE PHYSICAL THERAPY & SPORTS REHAB, P.S. |
| NPI Number: | 1356471684 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RONALD DEAN ENYEART (OWNER) |
| Mailing Address: | 2850 228th Ave Se Suite B Sammamish |
| State: | WA US |
| Postal Code: | 980759301 |
| Phone Number: | 4253914488 |
| Fax Number: | 4253918287 |
| NPI Enumeration Date: | 03/06/2007 |
| NPI Last Update Date: | 03/19/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2251X0800X |
| License Number: | PT00003047 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | Orthopedic |
| Taxonomy Definition: | |