Northwest Sports Performance

Primary specialty

Sports Physical TherapistTaxonomy code 2251S0007X

Legal business name

NORTHWEST SPORTS PERFORMANCE

Practice address

819 Pacific Ave
Tacoma, WA 98402-5209

Phone

(253) 215-6100

NPI assigned

Aug 8, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Kevin Lee Vandenbosch

Title

Manager

Phone

(206) 519-0135

Specialties & licenses 5

Addresses

Other identifiers 1

Tax ID family

Northwest Sports Performance2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Northwest Sports Performance

  • Massage Therapist
  • Puyallup, WA
  • NPI 1134894652
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1691452800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691452800000",
    "number": "1356024228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15916 93RD AVE E",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983756718",
            "telephone_number": "206-519-0135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "819 PACIFIC AVE",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984025209",
            "telephone_number": "253-215-6100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST SPORTS PERFORMANCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-08",
        "last_updated": "2023-08-08",
        "certification_date": "2023-08-08",
        "status": "A",
        "authorized_official_last_name": "VANDENBOSCH",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "206-519-0135",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "133N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nutritionist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2081S0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Sports Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2251S0007X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Sports",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225700000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Massage Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICAL THERAPIST NPI",
            "identifier": "1770083826",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Northwest Medical Specialties Pharmacy
• Northwest Medical Specialties PLLC
• Northwest Medical Specialties, PLLC
• Northwest Pediatric Heart Specialists PLLC
• Northwest Spine & Injury Care PLLC
• Northwest Urology Center PS
• Northwest Vision Care, Inc.
• Kylie Norton
• Katie Lee Noseworthy
• Cecile Nouaille

• Sports Physical Therapist in Tacoma, WA
• Providers in Tacoma, WA by specialty
• Sports Physical Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.