MEDICARE: LAURA LOUISE SPIERS BOUMA 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
1	225100000X	Physical Therapist	PT00010216	WA

General Provider Information

NPI Number	:	1265657043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA LOUISE SPIERS BOUMA DPT

Provider Business Mailing Address
First Line	:	1309 HARBOR AVE SW
Second Line	:	STE A
City	:	SEATTLE
State	:	WA
Zip	:	98116-1784
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2008 15TH AVE S
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98144-4218
Country	:	US
Telephone Number	:	206-215-3804
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2007
Last Update Date	:	01/05/2022

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