Healthcare Provider Details

I. General information

NPI: 1205156171
Provider Name (Legal Business Name): SUSANNE BOOTH ND, PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2010
Last Update Date: 03/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4923 US ROUTE 5
WESTMINSTER VT
05158-9651
US

IV. Provider business mailing address

PO BOX 452
SAXTONS RIVER VT
05154-0452
US

V. Phone/Fax

Practice location:
  • Phone: 802-722-4023
  • Fax:
Mailing address:
  • Phone: 206-919-9458
  • Fax: 802-722-4137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number040.0065254
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number0990080815
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: