Thomas Boettger, PT

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

19402 Issued in MD

Practice address

4801 Dorsey Hall Dr
Suite 130
Ellicott City, MD 21042-7766

Phone

(410) 730-9851

Fax

(410) 730-9855

NPI assigned

Sep 26, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1127692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1447246384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4801 DORSEY HALL DR",
            "address_2": "SUITE 130",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210427766",
            "telephone_number": "410-730-9851",
            "fax_number": "410-730-9855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4801 DORSEY HALL DR",
            "address_2": "SUITE 130",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210427766",
            "telephone_number": "410-730-9851",
            "fax_number": "410-730-9855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOETTGER",
        "first_name": "THOMAS",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MD",
            "license": "19402",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAMSI",
            "identifier": "263996",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CHOICE",
            "identifier": "6545-0002",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lois Lydia Bly, MA, PT
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• Eunice Borlagdan Bobis, PT
• Monica Laney Boddie, LCSW-C
• Katherine Bodenberg, D.C.
• Soheyla Bolouri, LCSW-C
• Robert Wayne Boman, D.D.S.
• Heather Bond-Pushman, LCSW-C
• Maryanne Bongiovani
• Bernard Bonsu

• Physical Medicine & Rehabilitation Physician in Ellicott City, MD
• Providers in Ellicott City, MD by specialty
• Physical Medicine & Rehabilitation Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.