Healthcare Provider Details

I. General information

NPI: 1851030134
Provider Name (Legal Business Name): ANTHONY DYLAN BOONE PT, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2022
Last Update Date: 06/03/2022
Certification Date: 06/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3183 SW 38TH CT
MIAMI FL
33146-1528
US

IV. Provider business mailing address

1 SIGNATURE POINT DR APT 1416
LEAGUE CITY TX
77573-6514
US

V. Phone/Fax

Practice location:
  • Phone: 305-501-0231
  • Fax:
Mailing address:
  • Phone: 270-227-9778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: