Provider Demographics
NPI:1942632385
Name:BOOTH, BRIAN CHRISTOPHER (DPT)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:CHRISTOPHER
Last Name:BOOTH
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 1:300 CROMMELIN DRIVE
Mailing Address - Street 2:
Mailing Address - City:WETUMPKA
Mailing Address - State:AL
Mailing Address - Zip Code:36092
Mailing Address - Country:US
Mailing Address - Phone:334-201-2852
Mailing Address - Fax:334-514-4424
Practice Address - Street 1:74240 TALLASSEE HWY
Practice Address - Street 2:
Practice Address - City:WETUMPKA
Practice Address - State:AL
Practice Address - Zip Code:36092-5504
Practice Address - Country:US
Practice Address - Phone:334-514-4488
Practice Address - Fax:334-514-4424
Is Sole Proprietor?:No
Enumeration Date:2013-08-08
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH6906225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist