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BOUMA ORTHOSPORT, LLC

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Company Details

Legal Name: BOUMA ORTHOSPORT, LLC
Jurisdiction: WASHINGTON
Entity Type: WA LIMITED LIABILITY COMPANY
Category: DOMESTIC ENTITY
Status: Active
Formation/ Registration Date: January 21st 2020
Expiration date: 31 Jan 2026
UBI Number: 604 572 106
ZIP code: 98116
City: Seattle
County: KING
Home State: WASHINGTON
Principal Office Street Address: Google Maps Logo 1309 HARBOR AVE SW, STE A, SEATTLE, WA, 98116-1784, UNITED STATES

Contact Details

E-Mail: MARKBOUMA@LAKEWASHINGTONPT.COM
Phone Number: +1 206-200-2495

Nature of Business

Health Care, Social Assistance & Service Organization

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Registered Agent Information

Name Role Address
MARK BOUMA Registered Agent 4037 46TH AVE SW, SEATTLE, WA, 98116-3725, UNITED STATES

Key Officers & Management

Name Role Address
MARK BOUMA Executor 4037 46TH AVE SW, SEATTLE, WA, 98116-3725, UNITED STATES
MARK BOUMA Governing Person 4037 46TH AVE SW, SEATTLE, WA, 98116-3725, UNITED STATES

National Provider Identifier

NPI Number:
1740803246
Certification Date:
2020-05-21

Authorized Person:

Name:
MARK JEFFREY BOUMA
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
261QP2000X - Physical Therapy Clinic/Center
Is Primary:
Yes

Contacts:

History

Type Old value New value Date of change
Name change SEATTLE ORTHOPEDIC AND SPORTS PHYSIO, LLC BOUMA ORTHOSPORT, LLC 2020-05-11
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