Provider Demographics
NPI:1952970097
Name:BOTTOMLY, ELIZABETH LAUREN (DPT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LAUREN
Last Name:BOTTOMLY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1824 LARCHMONT PL
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-5924
Mailing Address - Country:US
Mailing Address - Phone:856-449-9040
Mailing Address - Fax:
Practice Address - Street 1:1824 LARCHMONT PL
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-5924
Practice Address - Country:US
Practice Address - Phone:856-449-9040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01810500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist