MEDICARE: DR. MICHAEL KENT BOOTH PT, DPT, ATC, MS

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	2255A2300X	Athletic Trainer	25MT00302200	NJ
2	225100000X	Physical Therapist	PT031441	PA
3	225100000X	Physical Therapist	40QA02349300	NJ
4	2255A2300X	Athletic Trainer	RT007664	PA

General Provider Information

NPI Number	:	1811460082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL KENT BOOTH PT, DPT, ATC, MS

Provider Business Mailing Address
First Line	:	19 SHOEMAKER DR
Second Line	:
City	:	SWEDESBORO
State	:	NJ
Zip	:	08085-1256
Country	:	US
Telephone Number	:	609-805-7668
Fax Number	:

Provider Business Practice Location Address
First Line	:	484 CONCHESTER HWY
Second Line	:
City	:	ASTON
State	:	PA
Zip	:	19014-3129
Country	:	US
Telephone Number	:	610-494-4802
Fax Number	:	610-494-1206

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

Provider Enumeration Date	:	01/09/2019
Last Update Date	:	03/24/2026

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