Individual
MARY ELIZA BOTTORFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
411 E BROADWAY, COLUMBIA, COLUMBIA, MO 65201-4437
(573) 886-7411
(573) 443-7246
Mailing address
411 E BROADWAY, COLUMBIA, COLUMBIA, MO 65201-4437
(573) 886-7411
(573) 443-7246
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2009022345
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
145960001
MEDICARE PTAN
MO
Enumeration date
08/06/2009
Last updated
03/15/2019
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