Basic Information
| Provider Information | |||||||||
| NPI: | 1073074985 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOOHER | ||||||||
| FirstName: | KATHRYN | ||||||||
| MiddleName: | ELIZABETH RAND | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 DAREL ST. | ||||||||
| Address2: | |||||||||
| City: | ROCKY POINT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9109983232 | ||||||||
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| Practice Location | |||||||||
| Address1: | 318 S NORWOOD ST | ||||||||
| Address2: | |||||||||
| City: | WALLACE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284661446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102851799 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2019 | ||||||||
| LastUpdateDate: | 07/26/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 18587 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 18587 | 01 | NC | NC PT LICENSE # | OTHER |