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Organization
RENTON SPORTS & SPINE PT
Active
Organization
RENTON SPORTS & SPINE PT
Active
Other names
Renton Sports & Spine PT
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOEL M JOHNSON PT (PHYSICAL THERAPIST/CLINCI DIRECTOR)
(425) 917-9885
Entity
Organization
Contact information
Practice address
19400 108TH AVE SE, SUITE 100, KENT, WA 98031-0108
(425) 917-9885
(253) 277-0737
Mailing address
19400 108TH AVE SE, SUITE 100, KENT, WA 98031-0108
(425) 917-9885
(253) 277-0737
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT00002862
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
147035
DEPT OF VTT
WA
01
—
4465984
AETNA
—
01
—
5324J0
REGENCE BS
WA
01
—
650021468
RR MEDICARE
—
01
—
7293608
CIGNA
—
05
—
8351397
—
WA
Enumeration date
07/29/2005
Last updated
07/13/2016
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