Provider Demographics
NPI:1053314914
Name:BOTTENFIELD, TODD DOUGLAS (RPT)
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:DOUGLAS
Last Name:BOTTENFIELD
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1174
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34295-1174
Mailing Address - Country:US
Mailing Address - Phone:941-697-7737
Mailing Address - Fax:941-697-1688
Practice Address - Street 1:2961 PLACIDA RD
Practice Address - Street 2:STE 11
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34224-8525
Practice Address - Country:US
Practice Address - Phone:941-697-7737
Practice Address - Fax:941-697-1688
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT114822251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY043TOtherBC BS PROVIDER NUMBER
FLE5786BMedicare PIN
FLP00071384Medicare PIN
FLE5786BMedicare PIN