Provider Demographics
NPI:1134403017
Name:BOOTH, MEGAN ELIZABETH (DPT)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:ELIZABETH
Last Name:BOOTH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:ELIZABETH
Other - Last Name:BRASCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:4710 SPOTSYLVANIA PARKWAY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-1716
Mailing Address - Country:US
Mailing Address - Phone:540-479-4777
Mailing Address - Fax:540-710-0061
Practice Address - Street 1:4710 SPOTSYLVANIA PKWY
Practice Address - Street 2:SUITE 102
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-9433
Practice Address - Country:US
Practice Address - Phone:540-479-4777
Practice Address - Fax:540-710-0061
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305207133225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist