Provider Demographics
NPI:1902151400
Name:BOTROS, ANNA ADEEB (PT)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:ADEEB
Last Name:BOTROS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 COLUMBIA TER
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-1223
Mailing Address - Country:US
Mailing Address - Phone:518-229-2045
Mailing Address - Fax:
Practice Address - Street 1:17 COLUMBIA TER
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:07020-1223
Practice Address - Country:US
Practice Address - Phone:518-229-2045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-20
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034902225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist