Graduated: 1999
NPI: 1396746418
Practice Locations (2)
PRO-ACTIVE SPORTSMED PLLC
4219 6TH AVE SE, SUITE B
LACEY, WA 985031065
3604554448
PRO-ACTIVE SPORTSMED PLLC
111 TUMWATER BLVD SE, SUITE 113
TUMWATER, WA 985016422
3605283300
Source: CMS National Downloadable File, September 2026.