MEDICARE: BIOJUNCTION SPORTS THERAPY, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center	00009027	WA

General Provider Information

NPI Number	:	1134405822
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIOJUNCTION SPORTS THERAPY, PLLC

Provider Business Mailing Address
First Line	:	3727 CALIFORNIA AVE SW
Second Line	:	SUITE 1-A
City	:	SEATTLE
State	:	WA
Zip	:	98116-4303
Country	:	US
Telephone Number	:	206-938-0860
Fax Number	:	206-938-0866

Provider Business Practice Location Address
First Line	:	3727 CALIFORNIA AVE SW
Second Line	:	SUITE 1-A
City	:	SEATTLE
State	:	WA
Zip	:	98116-4303
Country	:	US
Telephone Number	:	206-938-0860
Fax Number	:	206-938-0866

Authorized Official
Title or Position	:	OWNER/PHYSICAL THERAPIST
Name	:	LORA JANE CLOTHIER
Credential	:	DPT
Telephone Number	:	206-938-0860

Provider Enumeration Date	:	10/26/2011
Last Update Date	:	01/09/2023

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