Provider Demographics
NPI:1851030134
Name:BOONE, ANTHONY DYLAN (PT, CSCS)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:DYLAN
Last Name:BOONE
Suffix:
Gender:M
Credentials:PT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SIGNATURE POINT DR APT 1416
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-6514
Mailing Address - Country:US
Mailing Address - Phone:270-227-9778
Mailing Address - Fax:
Practice Address - Street 1:3183 SW 38TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33146-1528
Practice Address - Country:US
Practice Address - Phone:305-501-0231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-03
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports