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General NPI Number Information
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NPI Number | 1669665626
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Entity Type | Individual
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Provider Name | JENNA BOERBOOM DPT
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Gender | Female
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Dates
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Enumeration Date | 08/23/2007
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Last Update Date | 05/01/2017
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Provider Practice Location Address
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Address Line | 17650 140TH AVE SE #B-07
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City | RENTON
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State | WA
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Zip | 98058-6814
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Country | US
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Telephone | 425-430-0700
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Fax | 425-430-0710
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Provider Business Mailing Address
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Address Line | 244 118TH AVE SE APT 28
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City | BELLEVUE
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State | WA
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Zip | 98005-3560
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Country | US
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Telephone | 319-270-4756
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | PT00010556
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PTL0014633
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License Number State | CO
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