Provider Demographics
NPI:1447305966
Name:BOTEL, LORETTA MARIE (MS, LPT)
Entity type:Individual
Prefix:
First Name:LORETTA
Middle Name:MARIE
Last Name:BOTEL
Suffix:
Gender:F
Credentials:MS, LPT
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:MARIE
Other - Last Name:BOTEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, LPT
Mailing Address - Street 1:320 CUSTER RD
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-5623
Mailing Address - Country:US
Mailing Address - Phone:972-490-9055
Mailing Address - Fax:972-490-9058
Practice Address - Street 1:320 CUSTER RD
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-5623
Practice Address - Country:US
Practice Address - Phone:972-490-9055
Practice Address - Fax:972-490-9058
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10283222251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics