Healthcare Provider Details

I. General information

NPI: 1790243624
Provider Name (Legal Business Name): KARA LANE BORTZ PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2019
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2999 ROSS CLARK CIR
DOTHAN AL
36301-1104
US

IV. Provider business mailing address

PO BOX 356
BURTONSVILLE MD
20866-0356
US

V. Phone/Fax

Practice location:
  • Phone: 334-714-2907
  • Fax:
Mailing address:
  • Phone: 301-421-1125
  • Fax: 301-500-2175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP051133T
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP051242T
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTH11091
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP051239T
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP051182T
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: