Healthcare Provider Details

I. General information

NPI: 1376454975
Provider Name (Legal Business Name): MAKENNA REBEKAH BOOSE DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 W PALMETTO PARK RD STE 201
BOCA RATON FL
33433-3430
US

IV. Provider business mailing address

11411 SW 21ST ST
MIRAMAR FL
33025-6624
US

V. Phone/Fax

Practice location:
  • Phone: 561-376-2573
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT45118
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT45118
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: