| Organization Name: | REBOOT CENTER FOR INNOVATIVE MEDICINE |
| NPI Number: | 1366711624 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JENNIFER V SCHIAVONE-RUTHENSTEINER (OWNER/MANAGER) |
| Mailing Address: | 5548 Myrtle Ave Suite 202 Freeland |
| State: | WA US |
| Postal Code: | 982498776 |
| Phone Number: | 3603312464 |
| Fax Number: | 8662777173 |
| NPI Enumeration Date: | 12/15/2011 |
| NPI Last Update Date: | 02/05/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM1300X |
| License Number: | NT00001312 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Multi-Specialty |
| Taxonomy Definition: | |