=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568241420
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JELENA BOJIC DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2023
-----------------------------------------------------
Last Update Date | 09/28/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3225 NE 125TH ST
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98125-4516
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-736-5880
-----------------------------------------------------
Fax | 206-838-1503
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8750 GREENWOOD AVE N STE S1
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98103-3684
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-782-5789
-----------------------------------------------------
Fax | 206-782-5794
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT61451971
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------