Provider Demographics
NPI:1821395062
Name:BOOTH, KATHRYN L (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:L
Last Name:BOOTH
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3939 DA VINCI DR
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-6480
Mailing Address - Country:US
Mailing Address - Phone:720-340-4263
Mailing Address - Fax:
Practice Address - Street 1:611 KORTE PARKWAY
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501
Practice Address - Country:US
Practice Address - Phone:303-776-1373
Practice Address - Fax:303-776-7471
Is Sole Proprietor?:No
Enumeration Date:2011-02-24
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3345225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist