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NPI Code Detail

MEDICARE: JENNA BOERBOOM DPT

MEDICARE: JENNA BOERBOOM DPT
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
1225100000XPhysical TherapistPT00010556WA
2225100000XPhysical TherapistPTL0014633CO

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1G8870253OTHERWAMEDICARE ID

General Provider Information

NPI Number : 1669665626
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNA BOERBOOM DPT
Provider Business Mailing Address
First Line : 244 118TH AVE SE
Second Line : APT 28
City : BELLEVUE
State : WA
Zip : 98005-3560
Country : US
Telephone Number : 319-270-4756
Fax Number :
Provider Business Practice Location Address
First Line : 17650 140TH AVE SE
Second Line : #B-07
City : RENTON
State : WA
Zip : 98058-6814
Country : US
Telephone Number : 425-430-0700
Fax Number : 425-430-0710
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/23/2007
Last Update Date : 05/01/2017

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Directions to “ JENNA BOERBOOM DPT” Practice Location

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