Booth, Matthew Ryan

Booth, Matthew Ryan is an individual health care provider with primary practice located at 415 E Parkcenter Blvd Suite 114, Boise ID 83706-6504. He recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, which is considered as his primary health care specialty. Booth, Matthew Ryan can be contacted via phone (208) 433-9211.

Contact Information

Primary practice address
415 E Parkcenter Blvd Suite 114 Boise ID 83706-6504
Phone: (208) 433-9211
Fax: (208) 433-9241
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X 3968 Oregon
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X RPT1329 Idaho

Profile Details

NPI number 1265416291
LBN Legal business name Booth, Matthew Ryan
Credentials Physical Therapist (PT)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 2nd, 2005
Last updated Oct 9th, 2014 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1265416291 NPPES
Idaho MEDICAID 805292000
Idaho MEDICAID 805292002
Idaho MEDICAID 1265416291-000
Idaho Other P00802453
Idaho Other 0330326
Idaho MEDICAID 126546291-002

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