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General NPI Number Information
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NPI Number | 1669235701
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Entity Type | Organization
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Legal Business Name | K. BOO PHYSICAL THERAPY AND PERFORMANCE LLC
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Dates
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Enumeration Date | 02/01/2024
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Last Update Date | 02/01/2024
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Provider Practice Location Address
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Address Line | 1527 SHILO SPRINGS RD
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City | LARAMIE
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State | WY
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Zip | 82070-8599
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Country | US
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Telephone | 785-202-1592
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Fax |
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Provider Business Mailing Address
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Address Line | 1565 N 22ND ST
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City | LARAMIE
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State | WY
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Zip | 82072-2387
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DPT/OWNER
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Name | JAMES BOO
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Credential | DPT
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Telephone | 785-202-1592
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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