Jenna Boerboom, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PTL0014633 Issued in CO

Practice address

17650 140TH Ave SE
#B-07
Renton, WA 98058-6814

Phone

(425) 430-0700

Fax

(425) 430-0710

NPI assigned

Aug 23, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1187827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1493596800000",
    "number": "1669665626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "244 118TH AVE SE",
            "address_2": "APT 28",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980053560",
            "telephone_number": "319-270-4756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17650 140TH AVE SE",
            "address_2": "#B-07",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980586814",
            "telephone_number": "425-430-0700",
            "fax_number": "425-430-0710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOERBOOM",
        "first_name": "JENNA",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-23",
        "last_updated": "2017-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT00010556",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CO",
            "license": "PTL0014633",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID",
            "identifier": "G8870253",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christl Joy Board, LMP
• Aaron Justin Bobb, MD
• Clinton T Bocanegra, LAT, ATC
• Barry I. Bockow, M.D.
• Bodyfix PT and Performance
• Shandra Noelle Boeve, PHARMD
• Tyshayna Boggs, NP
• Teanjya Kristine Bohag, LMP
• Jessica S Bohn, ARNP
• Ida Bojang

• Physical Therapist in Renton, WA
• Providers in Renton, WA by specialty
• Physical Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 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.