Provider Demographics
NPI:1821418054
Name:BOTROTH, MOHEB S (DPT)
Entity Type:Individual
Prefix:DR
First Name:MOHEB
Middle Name:S
Last Name:BOTROTH
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 BALTUSROL RD
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-3306
Mailing Address - Country:US
Mailing Address - Phone:347-459-6778
Mailing Address - Fax:
Practice Address - Street 1:71 BALTUSROL RD
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-3306
Practice Address - Country:US
Practice Address - Phone:347-459-6778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-28
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01471900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist