Individual
MATTHEW RYAN BOOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
415 E PARKCENTER BLVD, SUITE 114, BOISE, ID 83706-6504
(208) 433-9211
(208) 433-9241
Mailing address
16083 SW UPPER BOONES FERRY RD, SUITE 300, TIGARD, OR 97224-7736
(800) 219-8835
(503) 639-9699
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
3968
OR
225100000X
Physical Therapist
Primary
RPT1329
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0330326
WA L&I
ID
05
—
1265416291-000
—
ID
05
—
126546291-002
—
ID
05
—
805292000
—
ID
05
—
805292002
—
ID
01
—
P00802453
RR MEDICARE
ID
Enumeration date
12/02/2005
Last updated
10/09/2014
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