Provider Demographics
NPI:1588877864
Name:BOOKER, MERILEE GAMBLE (PT, MS, PCS)
Entity type:Individual
Prefix:MRS
First Name:MERILEE
Middle Name:GAMBLE
Last Name:BOOKER
Suffix:
Gender:F
Credentials:PT, MS, PCS
Other - Prefix:MRS
Other - First Name:MERILEE
Other - Middle Name:GAMBLE
Other - Last Name:JUDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 237
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:AR
Mailing Address - Zip Code:72735-0237
Mailing Address - Country:US
Mailing Address - Phone:479-575-0404
Mailing Address - Fax:479-575-0404
Practice Address - Street 1:609 W MAPLE AVE
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-5335
Practice Address - Country:US
Practice Address - Phone:479-750-6240
Practice Address - Fax:479-750-6627
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT 10472251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR59949OtherBLUE CROSS BLUE SHIELD