Provider Demographics
NPI:1306663430
Name:BOOTH, ELIZABETH ESTHER (LMT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ESTHER
Last Name:BOOTH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:546 N JEFFERSON LN STE 303
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-7104
Mailing Address - Country:US
Mailing Address - Phone:509-290-6406
Mailing Address - Fax:
Practice Address - Street 1:546 N JEFFERSON LN STE 303
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-7104
Practice Address - Country:US
Practice Address - Phone:509-290-6406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61573382225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist