Individual
MR. CHRISTOPHER TRENT BOOP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
3000 W ELM ST, SUITE 36, LIMA, OH 45805-2548
(419) 331-2161
Mailing address
20391 ELGIN CONVERSE RD, VENEDOCIA, OH 45894-9403
(419) 303-6296
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
9989
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2619125
—
OH
01
—
365466
ANTHEM PROVIDER NUMBER
OH
Enumeration date
05/16/2007
Last updated
07/09/2007
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