Basic Information
| Provider Information | |||||||||
| NPI: | 1932220621 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOTT | ||||||||
| FirstName: | CARRIE | ||||||||
| MiddleName: | JANE | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 155 WOOTTON ST | ||||||||
| Address2: | |||||||||
| City: | BOONTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070052250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9733342720 | ||||||||
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| Practice Location | |||||||||
| Address1: | 700 PASSAIC AVE | ||||||||
| Address2: | |||||||||
| City: | WEST CALDWELL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070066408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9735757576 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 40QA01096000 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.