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Organization
OLYMPIC SPORTS AND SPINE REHABILITATION PS
Active
Organization
OLYMPIC SPORTS AND SPINE REHABILITATION PS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. VERN J ESSENBERG JR. PT (CHIEF OPERATIONS OFFICER)
(253) 581-5200
Entity
Organization
Contact information
Practice address
8011 112TH STREET CT E, PUYALLUP, WA 98373-7814
(253) 848-0662
(253) 848-8567
Mailing address
9315 GRAVELLY LAKE DR SW, SUITE 306, LAKEWOOD, WA 98499-1574
(253) 581-5200
(253) 581-5203
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
225700000X
Massage Therapist
—
—
225X00000X
Occupational Therapist
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
192149400
OWCP
WA
01
—
42640
LABOR & INDUSTRIES
WA
05
—
7130271
—
WA
05
—
7681703
—
WA
01
—
8930571
L & I CRIME VICTIM PRGM
WA
01
—
CT1246
RAILROAD MEDICARE
WA
01
—
PO9605
REGENCE BLUE SHIELD
WA
Enumeration date
05/09/2006
Last updated
02/03/2016
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