NPI 1033586003

McKennizie Boodram, LAT

Practitioner Contractor Desoto, TX

Practice location

Address: 1525 Mountain Laurel Ln, Desoto, TX 75115-5394
Phone: (469) 260-8872

Registered specialties

Contractor Primary

Other Service Providers Taxonomy 171W00000X Licence AT6271 (TX)

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Registry record

NPI: 1033586003
Entity type: Individual
Sex (as registered): Female
NPI issued: 26 Aug 2015
Record last updated: 26 Aug 2015

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.