# COAST SPINE AND SPORTS MEDICINE PLLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Coast Injury Medicine
- **Organization subpart:** No

## Provider details

- **NPI number:** 1528876109
- **Authorized official:** SANDY CLEMENS (ACCESS MANAGER)
- **Authorized official phone:** (253) 648-1853

## Contact information

- **Practice address:** 12220 113TH AVE NE STE 110, KIRKLAND, WA 98034-6915
- **Practice address phone:** (253) 648-1853
- **Practice address fax:** (425) 800-9756
- **Mailing address:** 8012 112TH STREET CT E STE 120, PUYALLUP, WA 98373-7856
- **Mailing address phone:** (253) 648-1853
- **Mailing address fax:** (425) 800-9756

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |

## Other

- **Enumeration date:** 12/27/2024
- **Last updated:** 12/27/2024