Provider Demographics
NPI:1801035639
Name:BOTTORFF, CATHERINE JANE (DPT)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:JANE
Last Name:BOTTORFF
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80911
Mailing Address - Country:US
Mailing Address - Phone:719-392-7777
Mailing Address - Fax:719-392-7773
Practice Address - Street 1:328 MAIN STREET
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80911
Practice Address - Country:US
Practice Address - Phone:719-392-7777
Practice Address - Fax:719-392-7773
Is Sole Proprietor?:No
Enumeration Date:2009-02-18
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9958225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOA104227Medicare PIN