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:
Health care specialties
| Specialty | Code | License # | 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 10 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| 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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