Provider Demographics
NPI:1811143456
Name:BOOTH, MARJORIE GALVIN (PT)
Entity type:Individual
Prefix:MRS
First Name:MARJORIE
Middle Name:GALVIN
Last Name:BOOTH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6531 LANDMARK DR
Mailing Address - Street 2:STE E
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-5951
Mailing Address - Country:US
Mailing Address - Phone:435-649-7335
Mailing Address - Fax:435-649-7568
Practice Address - Street 1:6531 LANDMARK DR
Practice Address - Street 2:STE E
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-5951
Practice Address - Country:US
Practice Address - Phone:435-649-7335
Practice Address - Fax:435-649-7568
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6016284-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist