Provider Demographics
NPI:1710994041
Name:BOONE, DANIEL (PT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
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 1:189 ADAM SHEPHERD PKWY
Mailing Address - Street 2:SUITE 14
Mailing Address - City:SHEPHERDSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40165-6579
Mailing Address - Country:US
Mailing Address - Phone:502-955-7724
Mailing Address - Fax:502-955-5778
Practice Address - Street 1:189 ADAM SHEPHERD PKWY
Practice Address - Street 2:SUITE 14
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-6579
Practice Address - Country:US
Practice Address - Phone:502-955-7724
Practice Address - Fax:502-955-5778
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY003437174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000064465OtherANTHEM/BCBS
KY000000064465OtherANTHEM/BCBS