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General NPI Number Information
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NPI Number | 1992174452
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Entity Type | Individual
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Provider Name | SPENCER K BOOTHE PT
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Gender | Male
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Dates
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Enumeration Date | 09/15/2015
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Last Update Date | 12/11/2024
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Provider Practice Location Address
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Address Line | 119 HIGHWAY 80 E
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City | CLINTON
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State | MS
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Zip | 39056-4738
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Country | US
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Telephone | 601-708-1834
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Fax | 601-708-1837
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Provider Business Mailing Address
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Address Line | 303 ROCKBRIDGE DR
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City | MADISON
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State | MS
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Zip | 39110-6989
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Country | US
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Telephone | 601-278-3578
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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 | PT5603
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License Number State | MS
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