MEDICARE: BOOHER HEALTH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1215620380
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOOHER HEALTH LLC

Provider Business Mailing Address
First Line	:	3512 PENNSYLVANIA AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63118-3728
Country	:	US
Telephone Number	:	217-617-5652
Fax Number	:

Provider Business Practice Location Address
First Line	:	2724 SOUTHFIELD DR
Second Line	:
City	:	QUINCY
State	:	IL
Zip	:	62301-6530
Country	:	US
Telephone Number	:	217-617-5652
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	LAURA GEORGEOFF
Credential	:
Telephone Number	:	618-467-6707

Provider Enumeration Date	:	06/02/2023
Last Update Date	:	06/02/2023

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Directions to “BOOHER HEALTH LLC ” Practice Location

Language	Start Address	Practice Location

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