Provider Demographics
NPI:1942510888
Name:BOONE, LAURA EVELYN (RPTA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:EVELYN
Last Name:BOONE
Suffix:
Gender:F
Credentials:RPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2052 DORIS RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30906-2104
Mailing Address - Country:US
Mailing Address - Phone:229-532-5355
Mailing Address - Fax:
Practice Address - Street 1:2052 DORIS RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30906-2104
Practice Address - Country:US
Practice Address - Phone:229-532-5355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-13
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000099225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant