Provider Demographics
NPI:1578222535
Name:BOOKER, AMBER FAIR (MS, RCEP)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:FAIR
Last Name:BOOKER
Suffix:
Gender:F
Credentials:MS, RCEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5112 AUTUMNCREST DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-5801
Mailing Address - Country:US
Mailing Address - Phone:336-480-6310
Mailing Address - Fax:
Practice Address - Street 1:5500 ADAMS FARM LN STE 110
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-7060
Practice Address - Country:US
Practice Address - Phone:336-480-6310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-16
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC684655224Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist