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NPI Code Detail

MEDICARE: TARA CHRISTINE PEERENBOOM MA, ATC, AT/L

MEDICARE: TARA CHRISTINE PEERENBOOM MA, ATC, AT/L
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
12255A2300XAthletic TrainerA1 60037024WA

General Provider Information

NPI Number : 1548409931
Entity Type Code : Individual
Provider Name (Legal Business Name) : TARA CHRISTINE PEERENBOOM MA, ATC, AT/L
Provider Business Mailing Address
First Line : 4800 SAND POINT WAY NE
Second Line :
City : SEATTLE
State : WA
Zip : 98105-3901
Country : US
Telephone Number : 425-941-4874
Fax Number :
Provider Business Practice Location Address
First Line : 3013 S MOUNT BAKER BLVD
Second Line :
City : SEATTLE
State : WA
Zip : 98144-6139
Country : US
Telephone Number : 425-941-4874
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2009
Last Update Date : 02/09/2009

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