Organization
BOUMA ORTHOSPORT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK JEFFREY BOUMA DPT (OWNER)
(206) 200-2495
Entity
Organization
Contact information
Practice address
4037 46TH AVE SW, SEATTLE, WA 98116-3725
(206) 200-2495
Mailing address
4037 46TH AVE SW, SEATTLE, WA 98116-3725
(206) 200-2495
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
05/19/2020
Last updated
05/21/2020
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