Provider Demographics
NPI:1548095532
Name:BOOTH, AMY (MNT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:BOOTH
Suffix:
Gender:F
Credentials:MNT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4712 73RD AVENUE CT W
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4243
Mailing Address - Country:US
Mailing Address - Phone:253-381-3835
Mailing Address - Fax:
Practice Address - Street 1:7025 27TH ST W STE 1
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-5221
Practice Address - Country:US
Practice Address - Phone:253-970-5077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-07
Last Update Date:2024-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach