Provider Demographics
NPI:1760754527
Name:BOOTHE, KEVIN L (DPT)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:L
Last Name:BOOTHE
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 1:2413 PALOMINO PL
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-6572
Mailing Address - Country:US
Mailing Address - Phone:270-315-4497
Mailing Address - Fax:
Practice Address - Street 1:2413 PALOMINO PL
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-6572
Practice Address - Country:US
Practice Address - Phone:270-315-4497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-08
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY005977225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist