MEDICARE: LYNNETTE RENEE BOOTH PT, DPT

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	7968	SC
2	225100000X	Physical Therapist	2305204962	VA
3	225100000X	Physical Therapist	21641	MD
4	225100000X	Physical Therapist	70014963	IL
5	225100000X	Physical Therapist	870878	DC
6	225100000X	Physical Therapist
7	225100000X	Physical Therapist	PT014584	GA

General Provider Information

NPI Number	:	1669639332
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNNETTE RENEE BOOTH PT, DPT

Provider Business Mailing Address
First Line	:	4508 MERRYGOLD BLVD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44128-5037
Country	:	US
Telephone Number	:	202-460-9716
Fax Number	:

Provider Business Practice Location Address
First Line	:	2865B N DRUID HILLS RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30329-3924
Country	:	US
Telephone Number	:	404-228-3678
Fax Number	:

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

Provider Enumeration Date	:	05/20/2008
Last Update Date	:	02/21/2024

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