Individual
ALICIA A BOTHELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
9856 MONTGOMERY RD STE 300, CINCINNATI, OH 45242-6422
(513) 898-9022
(513) 216-8339
Mailing address
600 OAKMONT LN STE 600C, WESTMONT, IL 60559-5548
(630) 575-6200
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
070015286
IL
225100000X
Physical Therapist
Primary
PT018339
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1619908
BCBS IL GROUP NUMBER
IL
01
—
1623066
BCBS PROVIDER #
IL
01
—
367885100
US DEPT OF LABOR
IL
01
—
567700
MEDICARE GROUP NUMBER
IL
01
—
568080
MEDICARE GROUP NUMBER
IL
01
—
568150
MEDICARE GROUP NUMBER
IL
01
—
CJ4383
R.R. MEDICARE GROUP #
IL
Enumeration date
09/29/2006
Last updated
09/11/2019
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