Physician Compare National (NPI:1396789921)

HEALTHCARE PROVIDER: ANDRE BOTHA RPT, DIPMDT

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1396789921
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7012941974
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20141117001446
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BOTHA
	Individual professional last name
Provider First Name	ANDRE
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	PT
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1997
	Individual professional's medical school graduation year
Primary Specialty	PHYSICAL THERAPY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	130 ROCK POINT DR
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE C
	Group Practice or individual's line 2 address
City	DURANGO
	Group Practice or individual's city
State	CO
	Group Practice or individual's state
Zip Code	813017728
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y