MEDICARE: K. BOO PHYSICAL THERAPY AND PERFORMANCE 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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1669235701
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	K. BOO PHYSICAL THERAPY AND PERFORMANCE LLC

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

Provider Business Practice Location Address
First Line	:	1527 SHILO SPRINGS RD
Second Line	:
City	:	LARAMIE
State	:	WY
Zip	:	82070-8599
Country	:	US
Telephone Number	:	785-202-1592
Fax Number	:

Authorized Official
Title or Position	:	DPT/OWNER
Name	:	JAMES BOO
Credential	:	DPT
Telephone Number	:	785-202-1592

Provider Enumeration Date	:	02/01/2024
Last Update Date	:	02/01/2024

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