Individual
MR. ANDRE BOTHA
Active
Individual
MR. ANDRE BOTHA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPT, DIPMDT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4877
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00D021785-3
—
HI
01
—
375292YSK3
MEDICARE PTAN
CO
05
—
92882056
—
CO
Enumeration date
06/15/2006
Last updated
11/23/2020
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