Nathaniel S Bothfeld, PT

Key facts

NPI

1124376892

Entity type

Individual (NPI type 1)

Primary specialty

Physical Therapist 225100000X

License

12179-24 (WI)

Practice address

1650 Lee LN
Occupation Health Ports & Family Medicine Center
Beloit, WI 53511-3935

Phone

(608) 362-0211

Fax

(608) 364-4670

NPI assigned

Aug 28, 2012

Sex

Male

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 1, 2016.

{
    "created_epoch": "1346112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1456790400000",
    "number": "1124376892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1905 E. HUEBBE PARKWAY",
            "address_2": "BELOIT HEALTH SYSTEM INC",
            "city": "BELOIT",
            "state": "WI",
            "postal_code": "535111842",
            "telephone_number": "608-364-2200",
            "fax_number": "608-363-7395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 LEE LN",
            "address_2": "OCCUPATION HEALTH PORTS & FAMILY MEDICINE CENTER",
            "city": "BELOIT",
            "state": "WI",
            "postal_code": "535113935",
            "telephone_number": "608-362-0211",
            "fax_number": "608-364-4670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOTHFELD",
        "first_name": "NATHANIEL",
        "middle_name": "S",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-08-28",
        "last_updated": "2016-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "9109",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "12179-24",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MINNESOTA BOARD OF PHYSICALTHERAPY",
            "identifier": "9109",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Beloit, WI

• Blessed Beginnings, Inc.
• David Andrew Block, LPC, SAC-IT
• Brittany Noel Rowe Blomberg, D.O.
• John Works Boardman, MD
• Loria R. Boone
• Bouc Family Wellness Center, LLC
• Geoffrey Thomas Bouc, MD
• Peter Zenithen Bouc
• Erika Leigh Bourdeaux, DNP, RN, CPNP-PC
• Susan G Bower, MSN, RN, APNP

All providers in Beloit, WI · Physical Therapist in Wisconsin