Provider Demographics
NPI:1437228145
Name:BOOTH, RITA (PT)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:BOOTH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4809 N ARMENIA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-1447
Mailing Address - Country:US
Mailing Address - Phone:813-877-1930
Mailing Address - Fax:813-877-1938
Practice Address - Street 1:6460 SPALDING DR
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-1805
Practice Address - Country:US
Practice Address - Phone:770-840-8045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT31414225100000X
GAGA006979225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGA006979OtherSTATE LISC NUMBER