Provider Demographics
NPI:1407294325
Name:BOOMHOWER, CAROL JEAN (PTA)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:JEAN
Last Name:BOOMHOWER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2555 MORROW RD
Mailing Address - Street 2:
Mailing Address - City:HOME
Mailing Address - State:PA
Mailing Address - Zip Code:15747-7121
Mailing Address - Country:US
Mailing Address - Phone:724-397-2650
Mailing Address - Fax:
Practice Address - Street 1:154 HINDMAN RD
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-2417
Practice Address - Country:US
Practice Address - Phone:724-282-6806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE1000703225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant