Individual
MS. JILLIAN M BOUCEK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
19030 108TH AVE SE, STE 1, RENTON, WA 98055-6425
(425) 282-5048
Mailing address
15212 SE 276TH PL, KENT, WA 98042-4389
(425) 829-8737
Taxonomy
Speciality
Code
Description
License number
State
172M00000X
Mechanotherapist
Primary
MA00011013
WA
Other
Enumeration date
04/12/2007
Last updated
01/20/2009
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