Healthcare Provider Details

I. General information

NPI: 1891919098
Provider Name (Legal Business Name): TRICIA MARIE BOOTS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRICIA BOOTS BEATRICE

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20480 ROUTE 19 STE 101
CRANBERRY TOWNSHIP PA
16066-7501
US

IV. Provider business mailing address

801 YORK ST
MANITOWOC WI
54220-4630
US

V. Phone/Fax

Practice location:
  • Phone: 724-473-0660
  • Fax: 724-473-0665
Mailing address:
  • Phone: 920-663-9008
  • Fax: 920-684-1439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA002714L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: