Colter Bothwell
Individual provider Active NPI Physical Therapist · Wilsonville, OR
NPI 1093172249 · NPPES record last updated Jan 19, 2016
Key facts
- NPI
- 1093172249
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 7502 (AZ)
- Practice address
- 25117 SW Parkway Ave Ste D
Wilsonville, OR 97070-9697 - Phone
- (971) 224-2040
- NPI assigned
- Jan 19, 2016
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7502 | AZ | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 7502 | AZ | Yes |
Addresses
Primary practice location
25117 SW Parkway Ave Ste D
Wilsonville, OR 97070-9697
Mailing address
25117 SW Parkway Ave Ste D
Wilsonville, OR 97070-9697
Phone (971) 224-2040
Other providers in Wilsonville, OR
- Margaret A Boone
- Boone'S Landing Dental Center, LLC
- Boones Ferry Chiropractic and Massage PC
- Boones Landing Physical Therapy LLC
- Cindy D Bothum-Haslebacher
- Sara Denise Bourdon
- Jasyn-Christy Ann Bourne
- Ann Mariko Bouse
- Annika Bowlsby McBride
- Melissa Boyd
All providers in Wilsonville, OR · Physical Therapist in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 19, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.