Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | P14811 | NC |
NPI | 1275926438 |
---|---|
Provider Name | Kathryn Booth |
First Address | Boone, NC 28607-4926 |
Second Address | Boone, NC 28607-4926 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2015 |
Last Update Date | 12/03/2015 |