Provider Demographics
NPI:1639678923
Name:BOOHER, ALEXANDER (DPT)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:BOOHER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3512 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63118-3728
Mailing Address - Country:US
Mailing Address - Phone:217-617-5652
Mailing Address - Fax:
Practice Address - Street 1:3512 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63118-3728
Practice Address - Country:US
Practice Address - Phone:217-617-5652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-02
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018003404225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist