Individual
MR. ANDRE BOTHA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPT, DIPMDT
Contact information
Practice address
1600 FLORIDA RD, DURANGO, CO 81301-6836
(970) 385-6969
(970) 247-7810
Mailing address
130 ROCK POINT DR, STE C, DURANGO, CO 81301-7728
(970) 247-7895
(970) 459-8404
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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