Provider Demographics
NPI:1447213012
Name:BOEDE, MARK W (PT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:W
Last Name:BOEDE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1519 132ND ST SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-7203
Mailing Address - Country:US
Mailing Address - Phone:425-330-0633
Mailing Address - Fax:425-338-9637
Practice Address - Street 1:1519 132ND ST SE
Practice Address - Street 2:SUITE A
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-7203
Practice Address - Country:US
Practice Address - Phone:425-337-9556
Practice Address - Fax:425-357-9186
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0309BOOtherREGENCE
WA1838BOOtherREGENCE
WA911745305-98223-C004OtherTRICARE
WA0213610OtherDEPT. OF LABOR & INDUSTRY
WA8350183Medicaid
WA0273078OtherDEPT L/I
WA8350183OtherDSHS
WA8750BOOtherREGENCE BLUE SHIELD
WAP00414140OtherRAILROAD MEDICARE
WA0251421OtherL&I
WA1830BOOtherREGENCE BLUE SHIELD
WA7787375OtherAETNA
WA8940177OtherL & I CRIME VICTIMS
WA3568BOOtherREGENCE BLUE SHIELD
WA1838BOOtherREGENCE
WA8940177OtherL & I CRIME VICTIMS
WA8350183Medicaid
WA7787375OtherAETNA