Individual
THOMAS BOETTGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
4801 DORSEY HALL DR, SUITE 130, ELLICOTT CITY, MD 21042-7766
(410) 730-9851
(410) 730-9855
Mailing address
4801 DORSEY HALL DR, SUITE 130, ELLICOTT CITY, MD 21042-7766
(410) 730-9851
(410) 730-9855
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
19402
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
263996
MAMSI
MD
01
—
6545-0002
BLUE CHOICE
MD
Enumeration date
09/26/2005
Last updated
07/08/2007
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