Provider Demographics
NPI:1043271836
Name:BOEKE, THOMAS C (PT, ATC)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:C
Last Name:BOEKE
Suffix:
Gender:M
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 PENNSYLVANIA AVE SE STE 202
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-4344
Mailing Address - Country:US
Mailing Address - Phone:202-543-9400
Mailing Address - Fax:202-543-8990
Practice Address - Street 1:600 PENNSYLVANIA AVE SE STE 202
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-4344
Practice Address - Country:US
Practice Address - Phone:202-543-9400
Practice Address - Fax:202-543-8990
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305003259225100000X
DCPT870722225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA245010OtherANTHEM
DCG02816P03Medicare PIN
DCG02816Medicare PIN