Provider Demographics
NPI:1427265016
Name:BOOP, CHRISTOPHER TRENT (PT)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:TRENT
Last Name:BOOP
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20391 ELGIN CONVERSE RD
Mailing Address - Street 2:
Mailing Address - City:VENEDOCIA
Mailing Address - State:OH
Mailing Address - Zip Code:45894-9403
Mailing Address - Country:US
Mailing Address - Phone:419-303-6296
Mailing Address - Fax:
Practice Address - Street 1:3000 W ELM ST
Practice Address - Street 2:SUITE 36
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-2548
Practice Address - Country:US
Practice Address - Phone:419-331-2161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH9989225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2619125Medicaid
OH365466OtherANTHEM PROVIDER NUMBER
OHBO4161731Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE