Provider Demographics
NPI:1558614446
Name:BOOTH, MELISSA YVONNE (PT, DPT, PCS)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:YVONNE
Last Name:BOOTH
Suffix:
Gender:F
Credentials:PT, DPT, PCS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:201 DONAGHEY AVE
Mailing Address - Street 2:PT CENTER SUITE 308
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72035-5003
Mailing Address - Country:US
Mailing Address - Phone:501-450-5543
Mailing Address - Fax:501-450-5822
Practice Address - Street 1:3920 WOODLAND HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212-2495
Practice Address - Country:US
Practice Address - Phone:501-227-3600
Practice Address - Fax:501-227-4021
Is Sole Proprietor?:No
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AR705225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist