Organization
KITSAP PHYSICAL THERAPY LLC
Active
Other names
Kitsap Physical Therapy and Sports Clinics
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN ROBERT CARLSON PT (OWNER)
(360) 895-9090
Entity
Organization
Contact information
Practice address
1880 POTTERY AVE, SUITE 100, PORT ORCHARD, WA 98366-2518
(360) 895-9090
(360) 895-9089
Mailing address
1880 POTTERY AVE, SUITE 100, PORT ORCHARD, WA 98366-2518
(360) 895-9090
(360) 895-9089
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
602080097
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0150495
WA STATE DEPT OF LABOR IN
WA
05
—
7105166
—
WA
01
—
DB8089
RR MEDICARE
—
Enumeration date
05/04/2006
Last updated
04/07/2009
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