Provider Demographics
NPI:1093998015
Name:BOUSQUET, ROBIN JEANNE (MPT)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:JEANNE
Last Name:BOUSQUET
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:JEANNE
Other - Last Name:BERGQUIST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14780 SW OSPREY DR
Mailing Address - Street 2:SUITE 270
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-8028
Mailing Address - Country:US
Mailing Address - Phone:971-246-7478
Mailing Address - Fax:971-249-3191
Practice Address - Street 1:14780 SW OSPREY DR
Practice Address - Street 2:SUITE 270
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97007-8028
Practice Address - Country:US
Practice Address - Phone:971-246-7478
Practice Address - Fax:971-249-3191
Is Sole Proprietor?:No
Enumeration Date:2007-12-13
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 229752251P0200X
CAPT229752251S0007X
OR608902251P0200X, 2251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports