Individual
JENNA BOERBOOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
17650 140TH AVE SE, #B-07, RENTON, WA 98058-6814
(425) 430-0700
(425) 430-0710
Mailing address
244 118TH AVE SE, APT 28, BELLEVUE, WA 98005-3560
(319) 270-4756
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
PT00010556
WA
225100000X
Physical Therapist
Primary
PTL0014633
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G8870253
MEDICARE ID
WA
Enumeration date
08/23/2007
Last updated
05/01/2017
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