Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT34137 | FL |
N | 2251S0007X | Physical Therapist - Sports | PT34137 | FL |
NPI | 1538675210 |
---|---|
Provider Name | Jonathan Keith Boone |
First Address | Hollywood, FL 33019-3935 |
Second Address | Davie, FL 33314-1020 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2017 |
Last Update Date | 23/08/2020 |