Organization
PRO-ACTIVE SPORTSMED PLLC
Active
Other names
Vince A Gildener
Organization subpart
No
Provider details
NPI number
Authorized official
MIEKA EISEN (BUSINESS MANAGER)
(360) 528-3300
Entity
Organization
Contact information
Practice address
111 TUMWATER BLVD SE STE 113, TUMWATER, WA 98501-6422
(360) 528-3300
(360) 528-8162
Mailing address
111 TUMWATER BLVD SE STE 113, TUMWATER, WA 98501-6422
(360) 528-3300
(360) 528-8162
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7112923
—
WA
Enumeration date
05/02/2007
Last updated
03/12/2025
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