Provider Demographics
NPI:1659745230
Name:BOOMERANG PHYSICAL THERAPY
Entity Type:Organization
Organization Name:BOOMERANG PHYSICAL THERAPY
Other - Org Name:BOOMERANG THERAPY WORKS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KAEMMERLEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:360-258-1637
Mailing Address - Street 1:210 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-3493
Mailing Address - Country:US
Mailing Address - Phone:360-258-1637
Mailing Address - Fax:360-314-2627
Practice Address - Street 1:4201 NE 66TH AVE STE 104
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-3078
Practice Address - Country:US
Practice Address - Phone:360-258-1637
Practice Address - Fax:360-314-2627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-19
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009414261QP2000X
261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1710231592OtherNPI
1881119782OtherNPI
1962915058OtherNPI
1992083927OtherNPI
1417562133OtherNPI
1578121620OtherNPI