Individual
COLLEEN BOOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
71 HAYNES ST, MANCHESTER, CT 06040-4131
(860) 646-1222
Mailing address
104 PITKIN ST, MANCHESTER, CT 06040-4456
(860) 685-0816
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3964
CT
363AM0700X
Medical Physician Assistant
3964
CT
Other
Enumeration date
09/19/2017
Last updated
10/17/2018
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