Provider Demographics
NPI:1891811238
Name:BOTTORFF, JOSHUA LAWTON (PT)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:LAWTON
Last Name:BOTTORFF
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2435 RESEARCH PKWY
Mailing Address - Street 2:SUITE 255
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-1070
Mailing Address - Country:US
Mailing Address - Phone:719-260-8400
Mailing Address - Fax:719-260-8405
Practice Address - Street 1:600 S 21ST ST UNIT 130
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-3763
Practice Address - Country:US
Practice Address - Phone:719-634-1110
Practice Address - Fax:719-634-1112
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9974225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOA104938Medicare PIN