Jimmy S Bottoms Jr., PT
Individual provider Active NPI Physical Therapist · Boutiful, UT
NPI 1841362860 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1841362860
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 59430442401 (UT)
- Practice address
- 523 N Main Street
Boutiful, UT 84010 - Phone
- (801) 951-1607
- Fax
- (801) 951-1700
- NPI assigned
- Nov 14, 2006
- 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)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 59430442401 | UT | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 59430442401 | UT | Yes |
Addresses
Primary practice location
523 N Main Street
Boutiful, UT 84010
Mailing address
1437 W 2150 So
Syracuse, UT 84075
Phone (801) 773-2987
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| D6682 | Medicaid | UT |
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. 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.