Provider Demographics
NPI:1710274915
Name:BOOTH, JOSEPH V (MPT)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:V
Last Name:BOOTH
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8073 WASHINGTON VILLAGE DR
Mailing Address - Street 2:STE 110
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45458-1847
Mailing Address - Country:US
Mailing Address - Phone:330-631-0010
Mailing Address - Fax:330-631-0011
Practice Address - Street 1:129 5TH ST SE
Practice Address - Street 2:
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-4204
Practice Address - Country:US
Practice Address - Phone:330-631-0010
Practice Address - Fax:330-631-0011
Is Sole Proprietor?:No
Enumeration Date:2011-07-08
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT013148225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist