Jillian M Boucek, LMP

Primary specialty

MechanotherapistTaxonomy code 172M00000X

License

MA00011013 Issued in WA

Practice address

19030 108TH Ave SE
Ste 1
Renton, WA 98055-6425

Phone

(425) 282-5048

NPI assigned

Apr 12, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1232409600000",
    "number": "1275757197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15212 SE 276TH PL",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980424389",
            "telephone_number": "425-829-8737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19030 108TH AVE SE",
            "address_2": "STE 1",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980556425",
            "telephone_number": "425-282-5048"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUCEK",
        "first_name": "JILLIAN",
        "middle_name": "M",
        "name_prefix": "Ms.",
        "credential": "LMP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-12",
        "last_updated": "2009-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172M00000X",
            "taxonomy_group": "",
            "desc": "Mechanotherapist",
            "state": "WA",
            "license": "MA00011013",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elena Marie Bosque, ARNP
• Angela C Bosse, OTR/L
• Michael Scott Bostick, R.PH.
• Leon Kinley Boston
• Margaretha Johanna Botes Parker, RN
• Henry M Boudin, PHD
• Mary Anne Boudin, PHD
• Laurel A Boulds-Fisk, LMP
• Mark L Bowers, P.A.
• Aletha G Bowman, OT

• Mechanotherapist in Renton, WA
• Providers in Renton, WA by specialty
• Mechanotherapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.