Individual
GINA BOOTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMBT, MMT
Contact information
Practice address
711 N HWY 64, MANTEO, NC 27954
(252) 256-2717
Mailing address
129 DOLPHIN DR, MANTEO, NC 27954-9102
(252) 256-2717
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
11661
NC
Other
Enumeration date
10/24/2014
Last updated
10/24/2014
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