MEDICARE: CHRISTINE BOOHER

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	2251P0200X	Pediatric Physical Therapist	2305204619	VA
2	2251P0200X	Pediatric Physical Therapist	1353885	TX

General Provider Information

NPI Number	:	1366587909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE BOOHER

Provider Business Mailing Address
First Line	:	4912 RIVERBEND DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-2435
Country	:	US
Telephone Number	:	571-212-6145
Fax Number	:

Provider Business Practice Location Address
First Line	:	610 S JENNINGS AVE STE E
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-3209
Country	:	US
Telephone Number	:	682-231-2674
Fax Number	:

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

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	01/24/2024

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Directions to “ CHRISTINE BOOHER ” Practice Location

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