Provider Demographics
NPI:1467830240
Name:BOOSE, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:BOOSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1422 SCALES ST
Mailing Address - Street 2:APT. L
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27608-2468
Mailing Address - Country:US
Mailing Address - Phone:919-740-9022
Mailing Address - Fax:
Practice Address - Street 1:1422 SCALES ST
Practice Address - Street 2:APT. L
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27608-2468
Practice Address - Country:US
Practice Address - Phone:919-740-9022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-12
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP15609225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist