Provider Demographics
NPI:1487546586
Name:KEVIN VANDENBOSCH
Entity type:Organization
Organization Name:KEVIN VANDENBOSCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LET
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDENBOSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-519-0135
Mailing Address - Street 1:15916 93RD AVE E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-6718
Mailing Address - Country:US
Mailing Address - Phone:206-519-0135
Mailing Address - Fax:
Practice Address - Street 1:15916 93RD AVE E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-6718
Practice Address - Country:US
Practice Address - Phone:206-519-0135
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy