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NPI Code Detail

MEDICARE: MR. MARK BOOHER LPTA

MEDICARE: MR. MARK BOOHER LPTA
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
1225200000XPhysical Therapy Assistant2306000856VA

General Provider Information

NPI Number : 1821295361
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MARK BOOHER LPTA
Provider Business Mailing Address
First Line : 1716 FIVE FORKS RD
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23455-4324
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1628 OLD DONATION PKWY
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23454-3062
Country : US
Telephone Number : 757-496-3092
Fax Number : 757-496-2837
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2007
Last Update Date : 07/08/2007

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