Provider Demographics
NPI:1497371553
Name:BOOTE, KRISTINA (DPT)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:BOOTE
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 1:1800 W US HIGHWAY 223
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-8439
Mailing Address - Country:US
Mailing Address - Phone:517-263-3378
Mailing Address - Fax:517-263-4527
Practice Address - Street 1:1800 W US HIGHWAY 223
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-8439
Practice Address - Country:US
Practice Address - Phone:517-263-3378
Practice Address - Fax:517-263-4527
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-24
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501019615225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist