Provider Demographics
NPI:1134603657
Name:BOOKER, JOSEPH EDWARD II (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:EDWARD
Last Name:BOOKER
Suffix:II
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3240 W SILVER LAKE RD
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-1374
Mailing Address - Country:US
Mailing Address - Phone:810-714-4616
Mailing Address - Fax:810-714-4809
Practice Address - Street 1:3240 W SILVER LAKE RD
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-1374
Practice Address - Country:US
Practice Address - Phone:810-714-4616
Practice Address - Fax:810-714-4809
Is Sole Proprietor?:No
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501018879225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist