Provider Demographics
NPI:1255524500
Name:BOTTE, BEVERLY A (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:A
Last Name:BOTTE
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8040 COLRAIN DR
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-4405
Mailing Address - Country:US
Mailing Address - Phone:727-697-0652
Mailing Address - Fax:
Practice Address - Street 1:8040 COLRAIN DR
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-4405
Practice Address - Country:US
Practice Address - Phone:727-697-0652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA42990225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist