Provider Demographics
NPI:1629511852
Name:BOMES, JEFFREY (LMP)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:BOMES
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18250 142ND AVE NE
Mailing Address - Street 2:APT 423
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-4361
Mailing Address - Country:US
Mailing Address - Phone:425-420-8758
Mailing Address - Fax:
Practice Address - Street 1:18250 142ND AVE NE
Practice Address - Street 2:APT 423
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-4361
Practice Address - Country:US
Practice Address - Phone:425-420-8758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-20
Last Update Date:2016-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60538876225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist