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General NPI Number Information
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NPI Number | 1932986072
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Entity Type | Individual
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Provider Name | WILL PATRICK BOOTHE
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Gender | Male
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Dates
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Enumeration Date | 09/12/2023
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 1725 SCOTTSVILLE RD
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City | BOWLING GREEN
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State | KY
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Zip | 42104-3349
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Country | US
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Telephone | 270-467-9969
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 CORPORATE DR STE 400
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City | HOOVER
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State | AL
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Zip | 35242-5424
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Country | US
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Telephone | 972-850-3940
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 15097
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | CP034982T
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License Number State | KY
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