MEDICARE: MRS. WENDY JEAN BOOKER PT

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	11-02803	KS

General Provider Information

NPI Number	:	1295955094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. WENDY JEAN BOOKER PT

Provider Business Mailing Address
First Line	:	485 N KS HWY 2
Second Line	:
City	:	ANTHONY
State	:	KS
Zip	:	67003-2526
Country	:	US
Telephone Number	:	620-914-1200
Fax Number	:

Provider Business Practice Location Address
First Line	:	108 E ROSS ST
Second Line	:
City	:	CLEARWATER
State	:	KS
Zip	:	67026-7821
Country	:	US
Telephone Number	:	620-584-3777
Fax Number	:	620-584-6777

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

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	08/25/2020

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