Provider Demographics
NPI:1336119833
Name:BOOKER, YVETTE MARIE (P T)
Entity Type:Individual
Prefix:MS
First Name:YVETTE
Middle Name:MARIE
Last Name:BOOKER
Suffix:
Gender:F
Credentials:P T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 TREMONT ST
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77550-7904
Mailing Address - Country:US
Mailing Address - Phone:409-763-7025
Mailing Address - Fax:409-763-8648
Practice Address - Street 1:1810 TREMONT ST
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77550-7904
Practice Address - Country:US
Practice Address - Phone:409-763-7025
Practice Address - Fax:409-763-8648
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10827412251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0045GROtherBCBS GROUP #
TX89995TOtherBCBS PROVIDER #
TX00197SOtherMEDICARE GROUP #
TX89995TOtherBCBS PROVIDER #
TX0045GROtherBCBS GROUP #