Individual
BOONE ROGERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
240 LILLIE DALE DR, CAMDENTON, MO 65020-8505
(573) 346-2228
Mailing address
240 LILLIE DALE DR, CAMDENTON, MO 65020-8505
Taxonomy
Speciality
Code
Description
License number
State
2251G0304X
Geriatric Physical Therapist
Primary
2005000469
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2005000469
STATE LICENSE NUMBER
—
Enumeration date
06/30/2010
Last updated
06/30/2010
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