Provider Demographics
NPI:1073074985
Name:BOOHER, KATHRYN ELIZABETH RAND (DPT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ELIZABETH RAND
Last Name:BOOHER
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 1:10 DAREL ST.
Mailing Address - Street 2:
Mailing Address - City:ROCKY POINT
Mailing Address - State:NC
Mailing Address - Zip Code:28457
Mailing Address - Country:US
Mailing Address - Phone:910-998-3232
Mailing Address - Fax:
Practice Address - Street 1:318 S NORWOOD ST
Practice Address - Street 2:
Practice Address - City:WALLACE
Practice Address - State:NC
Practice Address - Zip Code:28466-1446
Practice Address - Country:US
Practice Address - Phone:910-285-1799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18587225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC18587OtherNC PT LICENSE #