Provider Demographics
NPI:1861401218
Name:BOOTH, WILLIAM E (PT)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:E
Last Name:BOOTH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 NEW FIDELITY CT
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-2665
Mailing Address - Country:US
Mailing Address - Phone:919-258-2714
Mailing Address - Fax:410-648-4878
Practice Address - Street 1:400 KEISLER DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-7069
Practice Address - Country:US
Practice Address - Phone:919-781-9950
Practice Address - Fax:919-783-9950
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2156225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6400294OtherUHC
NC127NWOtherBCBSNC
NC75524OtherMEDCOST
NCP00314336Medicare PIN
NC2500805Medicare PIN