Provider Demographics
NPI:1598135881
Name:BOOTH, CAROLINE (PT, ATC)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:BOOTH
Suffix:
Gender:F
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1096 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-4942
Mailing Address - Country:US
Mailing Address - Phone:419-353-7003
Mailing Address - Fax:419-353-7330
Practice Address - Street 1:1096 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-4942
Practice Address - Country:US
Practice Address - Phone:419-353-7003
Practice Address - Fax:419-353-7330
Is Sole Proprietor?:No
Enumeration Date:2015-09-30
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH011811225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist