Individual
MACKENZIE BOOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
1120 SFH, BRIGHAM YOUNG UNIVERSITY, PROVO, UT 84602
(801) 866-6082
Mailing address
859 HOLROYD DR, OGDEN, UT 84403-4512
(801) 866-6082
Taxonomy
Speciality
Code
Description
License number
State
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
Primary
10312376-4810
UT
Other
Enumeration date
07/29/2017
Last updated
07/29/2017
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