Provider Demographics
NPI:1730356122
Name:CORPORE SANO LLC
Entity type:Organization
Organization Name:CORPORE SANO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:
Authorized Official - Last Name:MOEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:425-482-2453
Mailing Address - Street 1:6161 NE 175TH ST
Mailing Address - Street 2:STE 203
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028-4800
Mailing Address - Country:US
Mailing Address - Phone:425-482-2453
Mailing Address - Fax:425-482-2452
Practice Address - Street 1:6161 NE 175TH ST
Practice Address - Street 2:STE 203
Practice Address - City:KENMORE
Practice Address - State:WA
Practice Address - Zip Code:98028-4800
Practice Address - Country:US
Practice Address - Phone:425-482-2453
Practice Address - Fax:425-482-2452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA5791261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy