Provider Demographics
NPI:1841740511
Name:BOONE, AMANDA KAITLYN (PT, DPT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:KAITLYN
Last Name:BOONE
Suffix:
Gender:F
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 1:7205 ESTERO BLVD UNIT 5
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33931-4786
Mailing Address - Country:US
Mailing Address - Phone:301-751-9831
Mailing Address - Fax:239-314-5119
Practice Address - Street 1:7205 ESTERO BLVD UNIT 5
Practice Address - Street 2:
Practice Address - City:FORT MYERS BEACH
Practice Address - State:FL
Practice Address - Zip Code:33931-4786
Practice Address - Country:US
Practice Address - Phone:239-314-5118
Practice Address - Fax:239-314-5119
Is Sole Proprietor?:No
Enumeration Date:2016-10-06
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305210593225100000X
GAPT013383225100000X
FLPT32135225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist