MEDICARE: JAMES BOO

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	PT-1582	WY

General Provider Information

NPI Number	:	1295117364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES BOO

Provider Business Mailing Address
First Line	:	1565 N 22ND ST
Second Line	:
City	:	LARAMIE
State	:	WY
Zip	:	82072-2387
Country	:	US
Telephone Number	:	307-343-2905
Fax Number	:	307-509-5412

Provider Business Practice Location Address
First Line	:	1527 SHILO SPRINGS RD
Second Line	:
City	:	LARAMIE
State	:	WY
Zip	:	82070-8599
Country	:	US
Telephone Number	:	307-343-2905
Fax Number	:	307-509-5412

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2015
Last Update Date	:	04/06/2026

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Directions to “ JAMES BOO ” Practice Location

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