=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003163775
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANDREW COTHAM PHYSICAL THERAPY P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/12/2012
-----------------------------------------------------
Last Update Date | 08/12/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 50 ALESSANDRO PL SUITE A40
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91105-3149
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-401-1935
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3311 CALIFORNIA AVE
-----------------------------------------------------
City | EL MONTE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91731-3133
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-401-1935
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PREIDENT/CEO
-----------------------------------------------------
Name | MR. ANDREW COTHAM
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 323-401-1935
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------