Provider Demographics
NPI:1538275151
Name:BOATRIGHT, MICHELE
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:BOATRIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12139 LADUE HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6656
Mailing Address - Country:US
Mailing Address - Phone:314-579-9194
Mailing Address - Fax:
Practice Address - Street 1:10859 W FLORISSANT AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-2405
Practice Address - Country:US
Practice Address - Phone:314-521-3000
Practice Address - Fax:314-521-7800
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO02119OtherLICENSE #