Basic Information
| Provider Information | |||||||||
| NPI: | 1841740511 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOONE | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | KAITLYN | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7205 ESTERO BLVD UNIT 5 | ||||||||
| Address2: | |||||||||
| City: | FORT MYERS BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339314786 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017519831 | ||||||||
| FaxNumber: | 2393145119 | ||||||||
| Practice Location | |||||||||
| Address1: | 7205 ESTERO BLVD UNIT 5 | ||||||||
| Address2: | |||||||||
| City: | FORT MYERS BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339314786 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2393145118 | ||||||||
| FaxNumber: | 2393145119 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2016 | ||||||||
| LastUpdateDate: | 04/08/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2305210593 | VA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PT013383 | GA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PT32135 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.