Organization
PRO-ACTIVE SPORTSMED PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. VINCE A GILDNER PT, ATC, CSCS (CLINIC DIRECOR)
(360) 528-3300
Entity
Organization
Contact information
Practice address
111 TUMWATER BLVD SE STE 113, TUMWATER, WA 98501-6422
(605) 283-3003
(360) 528-8162
Mailing address
4200 6TH AVE SE STE 203, LACEY, WA 98503-1042
(360) 455-4448
(360) 455-9833
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
04/26/2007
Last updated
03/14/2025
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