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Individual
NATHANIEL S BOTHFELD
Active
Individual
NATHANIEL S BOTHFELD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
12179-24
WI
225100000X
Physical Therapist
9109
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9109
MINNESOTA BOARD OF PHYSICALTHERAPY
MN
Enumeration date
08/28/2012
Last updated
03/01/2016
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