# PUGET SOUND SPECIALTY PHYSICIANS PLLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** PUGET SOUND SPECIALTY PHYSICIANS PLLC
- **Other names:** Ankle & Foot Specialist of Bonney Lake
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1144401704
- **Legal business name:** PUGET SOUND SPECIALTY PHYSICIANS PLLC
- **Authorized official:** TINA M QUEVEDO (BILLING OFFICE SUPERVISOR)
- **Authorized official phone:** (253) 841-2006

## Contact information

- **Practice address:** 19820 HWY 410 EAST, BONNEY LAKE, WA 98391
- **Practice address phone:** (253) 848-6656
- **Practice address fax:** (253) 840-6691
- **Mailing address:** 2728 E MAIN AVE, SUITE A, PUYALLUP, WA 98372-3198
- **Mailing address phone:** (253) 841-2006
- **Mailing address fax:** (253) 840-6691

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | WA | Yes |

## Other

- **Enumeration date:** 11/23/2007
- **Last updated:** 06/05/2008