Healthcare Provider Details

I. General information

NPI: 1891811238
Provider Name (Legal Business Name): JOSHUA LAWTON BOTTORFF PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 07/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S 21ST ST UNIT 130
COLORADO SPRINGS CO
80904-3763
US

IV. Provider business mailing address

2435 RESEARCH PKWY SUITE 255
COLORADO SPRINGS CO
80920-1070
US

V. Phone/Fax

Practice location:
  • Phone: 719-634-1110
  • Fax: 719-634-1112
Mailing address:
  • Phone: 719-260-8400
  • Fax: 719-260-8405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9974
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: