Organization
BELLEVUE SPORTS MEDICINE CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEELY J KOWALCHUK PT (DIRECTOR)
(425) 455-0699
Entity
Organization
Contact information
Practice address
11400 SE 6TH ST, SUITE 130, BELLEVUE, WA 98004-6423
(425) 455-0699
(425) 455-1541
Mailing address
11400 SE 6TH ST, SUITE 130, BELLEVUE, WA 98004-6423
(425) 455-0699
(425) 455-1541
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT00010137
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0030120
WA DEPT LABOR AND INDUSTR
WA
Enumeration date
08/10/2006
Last updated
12/05/2007
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