Organization
J & J ADVENTURES, LLC
Active
Other names
STAR Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN P PETRINOVICH P.T. (OWNER)
(253) 272-6910
Entity
Organization
Contact information
Practice address
1901 S CEDAR ST, STE. B-1, TACOMA, WA 98405-2308
(253) 272-6910
(253) 383-4218
Mailing address
1901 S CEDAR ST, STE. B-1, TACOMA, WA 98405-2308
(253) 272-6910
(253) 383-4218
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
602507009
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0197666
DEPT OF LABOR & INDUSTRY
WA
01
—
5508JA
PREMERA BLUE CROSS
WA
05
—
7131824
—
WA
Enumeration date
04/10/2006
Last updated
10/20/2008
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