Provider Demographics
NPI:1841292836
Name:BOONE, DEBORA L (PT)
Entity type:Individual
Prefix:
First Name:DEBORA
Middle Name:L
Last Name:BOONE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 BOAR RD
Mailing Address - Street 2:
Mailing Address - City:MOHRSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19541-8975
Mailing Address - Country:US
Mailing Address - Phone:610-916-6446
Mailing Address - Fax:
Practice Address - Street 1:1270 BROADCASTING RD
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-3203
Practice Address - Country:US
Practice Address - Phone:610-372-1140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT003874L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA023756M9SMedicare ID - Type Unspecified