Larissa Bomberger

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

60603 Issued in OR

Practice address

610 Sunset Dr
La Grande, OR 97850-1269

Phone

(541) 963-1437

NPI assigned

Dec 11, 2017

Last updated

Dec 11, 2017By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Snowflake Warriors Physical Therapy

  • Physical Therapy Clinic/Center
  • La Grande, OR
  • NPI 1417787136
  NPD Authorized official

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

{
    "created_epoch": "1512950400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1512950400000",
    "number": "1649785726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "408 N AVE",
            "city": "LA GRANDE",
            "state": "OR",
            "postal_code": "978501453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 SUNSET DR",
            "city": "LA GRANDE",
            "state": "OR",
            "postal_code": "978501269",
            "telephone_number": "541-963-1437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOMBERGER",
        "first_name": "LARISSA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-11",
        "last_updated": "2017-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OR",
            "license": "60603",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sherry D. Blakely, RN
• Blue Mountain Associates, LLC
• Lacey Bluhm
• Kimberly Bolen
• Tara Wulff Bolka, FNP-C
• Bond Total Healthcare PC
• William C. Bond, DC
• Molly Bottjen
• Zoe Boughn
• Vanessa Renae Braden

• Physical Therapist in La Grande, OR
• Providers in La Grande, OR by specialty
• Physical Therapist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2017; 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.