Provider Demographics
NPI:1700877107
Name:BOON, ERIN KATHRYN (DPT)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:KATHRYN
Last Name:BOON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24228 SE 39TH ST
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98029-7564
Mailing Address - Country:US
Mailing Address - Phone:425-391-4488
Mailing Address - Fax:425-391-8287
Practice Address - Street 1:2850 228TH AVE SE
Practice Address - Street 2:SUITE B
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98075-9301
Practice Address - Country:US
Practice Address - Phone:425-391-4488
Practice Address - Fax:425-391-8287
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008639225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB27326Medicare ID - Type UnspecifiedPROVIDER ID NUMBER