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LAKE SAMMAMISH PHYSICAL THERAPY, PLLC

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Company Details

Legal Name: LAKE SAMMAMISH PHYSICAL THERAPY, PLLC
Jurisdiction: WASHINGTON
Entity Type: WA PROFESSIONAL LIMITED LIABILITY COMPANY
Category: DOMESTIC ENTITY
Status: Active
Formation/ Registration Date: December 18th 2015
Expiration date: 31 Dec 2025
UBI Number: 601 131 205
ZIP code: 98027
City: Issaquah
County: KING
Home State: WASHINGTON
Principal Office Street Address: Google Maps Logo 6520 226TH PL SE STE 201, ISSAQUAH, WA, 98027-8969, UNITED STATES
Principal Office Mailing Address: Google Maps Logo 1650 LYNDON FARM CT, STE 300, LOUISVILLE, KY, 40223, UNITED STATES
Supporting healthcare providers fighting with COVID-19: $2,850

Contact Details

E-Mail: LEGAL@GOCONFLUENT.COM

Nature of Business

Health Care, Social Assistance & Service Organization

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Registered Agent Information

Name Role
CORPORATION SERVICE COMPANY Registered Agent

Key Officers & Management

Name Role
ROBERT TUTLAND Governing Person
BENJAMIN S SHARPE Governing Person

National Provider Identifier

NPI Number:
1740407816
Certification Date:
2020-11-27

Authorized Person:

Name:
DWAN DIAZ
Role:
CREDENTIALING COORDINATOR
Phone:

Taxonomy:

Selected Taxonomy:
133V00000X - Registered Dietitian
Is Primary:
No
Selected Taxonomy:
225X00000X - Occupational Therapist
Is Primary:
No
Selected Taxonomy:
332B00000X - Durable Medical Equipment & Medical Supplies
Is Primary:
No
Selected Taxonomy:
225100000X - Physical Therapist
Is Primary:
Yes

Contacts:

Fax:
4254520704
Fax:
4253913670

History

Type Old value New value Date of change
Name change LAKE SAMMAMISH PHYSICAL THERAPY, LLC LAKE SAMMAMISH PHYSICAL THERAPY, PLLC 2018-09-28
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