Provider Demographics
NPI:1144426032
Name:BOOTH, AMY M (PTA)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:M
Last Name:BOOTH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1420 BAY TREE RD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31639-9149
Mailing Address - Country:US
Mailing Address - Phone:229-686-9470
Mailing Address - Fax:912-383-5677
Practice Address - Street 1:100 DOCTORS DR
Practice Address - Street 2:SUITE 105
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-2210
Practice Address - Country:US
Practice Address - Phone:912-383-5645
Practice Address - Fax:912-383-5677
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA000825225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant