Provider Demographics
NPI:1316554702
Name:BOTSIS, INGRID (PT)
Entity Type:Individual
Prefix:
First Name:INGRID
Middle Name:
Last Name:BOTSIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 FRANKLIN ST STE 209
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-6236
Mailing Address - Country:US
Mailing Address - Phone:508-309-3450
Mailing Address - Fax:508-463-4326
Practice Address - Street 1:475 FRANKLIN ST STE 209
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-6236
Practice Address - Country:US
Practice Address - Phone:508-309-3450
Practice Address - Fax:508-463-4326
Is Sole Proprietor?:No
Enumeration Date:2020-09-29
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16065225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist