Provider Demographics
NPI:1841212479
Name:BOONE, MEA ELIZABETH (PT)
Entity Type:Individual
Prefix:MRS
First Name:MEA
Middle Name:ELIZABETH
Last Name:BOONE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4224 W FREEPORT ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-8628
Mailing Address - Country:US
Mailing Address - Phone:918-249-3420
Mailing Address - Fax:
Practice Address - Street 1:4705 W URBANA ST
Practice Address - Street 2:SUITE B
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-5998
Practice Address - Country:US
Practice Address - Phone:918-872-6677
Practice Address - Fax:918-893-6402
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK25342251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
244421803Medicare ID - Type Unspecified