Provider Demographics
NPI:1659559193
Name:BOONE, MICHAEL ROY (PT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ROY
Last Name:BOONE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5350 W NEW MARKET RD
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45133-7722
Mailing Address - Country:US
Mailing Address - Phone:937-393-1904
Mailing Address - Fax:
Practice Address - Street 1:5350 W NEW MARKET RD
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133-7722
Practice Address - Country:US
Practice Address - Phone:937-393-1904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-07
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5363225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist