Mark J Bouma, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT00010212 Issued in WA

Practice address

7650 SE 27TH St
Suite 112
Mercer Island, WA 98040-3060

Phone

(206) 230-8320

Fax

(206) 230-8315

NPI assigned

Aug 8, 2006

Sex

Male

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

Enrolled in WA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lake Washington Physical Therapy LLCGroup PAC ID 3476679812, 54 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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

• Lake Washington Physical Therapy LLC

  • Physical Therapy Clinic/Center
  • Kirkland, WA
  • NPI 1770894990

  Physical Therapist, WA

  Medicare reassignment Care Compare group NPD
• Seattle Orthopedic & Sports Physical Therapy, Inc.

  • Physical Therapist
  • Seattle, WA
  • NPI 1861660532
  Medicare reassignment NPD
• Washington Luna Care Physical Therapy LLC

  • Physical Therapist
  • Bellevue, WA
  • NPI 1346808052
  Medicare reassignment NPD
• Bouma Orthosport, LLC

  • Physical Therapy Clinic/Center
  • Seattle, WA
  • NPI 1740803246
  NPD Authorized official
• Olympic Physical Therapy, Inc.

  • Physical Therapist
  • Mercer Island, WA
  • NPI 1821057332
  NPD (past)

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

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611187200000",
    "number": "1659381069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1309 HARBOR AVE SW",
            "address_2": "STE A",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981161784",
            "telephone_number": "630-296-2223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7650 SE 27TH ST",
            "address_2": "SUITE 112",
            "city": "MERCER ISLAND",
            "state": "WA",
            "postal_code": "980403060",
            "telephone_number": "206-230-8320",
            "fax_number": "206-230-8315"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "68 Willow Rd",
            "address_purpose": "LOCATION",
            "city": "Menlo Park",
            "state": "CA",
            "postal_code": "940253653",
            "country_code": "US",
            "telephone_number": "866-839-6979",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "13315 68th Pl NE",
            "address_purpose": "LOCATION",
            "city": "Kirkland",
            "state": "WA",
            "postal_code": "980341650",
            "country_code": "US",
            "telephone_number": "866-839-6979",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOUMA",
        "first_name": "MARK",
        "middle_name": "J",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-08",
        "last_updated": "2021-01-21",
        "certification_date": "2021-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT00010212",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mathew Scott Bliss, LMP
• James M Blue, M.D.
• Katherine Perry Blumstein, PHD
• Elisha Bobrosky, LMP
• Alissa Ford Borda, DMD, MPH, MS
• Dawn April Bova, DMD
• Deshawn Edward Bowen-Aitkens, LMP
• Laura Anne Bowlin, LMFTA
• Brad Judy, DDS, PLLC
• Sonja Bradford, MS, CCC-SLP

• All providers in Mercer Island, WA
• Physical Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.