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General NPI Number Information
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NPI Number | 1336614619
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Entity Type | Organization
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Legal Business Name | BOOST PHYSICAL THERAPY PLLC
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Dates
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Enumeration Date | 10/12/2018
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Last Update Date | 01/22/2019
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Provider Practice Location Address
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Address Line | 14021 NE 8TH ST STE A
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City | BELLEVUE
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State | WA
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Zip | 98007-4135
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Country | US
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Telephone | 425-463-8920
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Fax |
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Provider Business Mailing Address
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Address Line | 23313 SE 32ND WAY
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City | SAMMAMISH
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State | WA
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Zip | 98075-6086
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Country | US
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Telephone | 425-463-8920
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | YUN DUAN
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Credential |
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Telephone | 425-463-8920
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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