Provider Demographics
NPI:1942373873
Name:BOTERO, DOLLY M (PT)
Entity Type:Individual
Prefix:MRS
First Name:DOLLY
Middle Name:M
Last Name:BOTERO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4005 NW 114 AVE
Mailing Address - Street 2:SUITE 20
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178
Mailing Address - Country:US
Mailing Address - Phone:786-621-7860
Mailing Address - Fax:786-621-7861
Practice Address - Street 1:4005 NW 114 AVE
Practice Address - Street 2:SUITE 20
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178
Practice Address - Country:US
Practice Address - Phone:786-621-7860
Practice Address - Fax:786-621-7861
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE5751ZMedicare ID - Type Unspecified