Provider Demographics
NPI:1952744039
Name:BOETTCHER, CHRISTOPHER WAYNE (PT, DPT)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:WAYNE
Last Name:BOETTCHER
Suffix:
Gender:M
Credentials:PT, DPT
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Mailing Address - Street 1:501 FOREST LANE SUITE A
Mailing Address - Street 2:EXCEL REHABILITATION AND SPORTS ENHANCEMENT
Mailing Address - City:CLEMSON
Mailing Address - State:SC
Mailing Address - Zip Code:29631-2621
Mailing Address - Country:US
Mailing Address - Phone:864-654-2001
Mailing Address - Fax:800-305-7112
Practice Address - Street 1:501 FOREST LANE SUITE A
Practice Address - Street 2:EXCEL REHABILITATION AND SPORTS ENHANCEMENT
Practice Address - City:CLEMSON
Practice Address - State:SC
Practice Address - Zip Code:29631-2621
Practice Address - Country:US
Practice Address - Phone:864-654-2001
Practice Address - Fax:800-305-7112
Is Sole Proprietor?:No
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6921225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist