Individual
BRYAN M BOOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
74910 AZTEC RD, PALM DESERT, CA 92260-3101
(916) 880-8858
Mailing address
80123 QUEENSBORO DR, INDIO, CA 92201-0523
(916) 880-8858
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2000026488
CA
Other
Enumeration date
10/04/2017
Last updated
10/04/2017
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