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General NPI Number Information
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NPI Number | 1164705059
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Entity Type | Individual
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Provider Name | ANDREW JEREMIAH ROTH DPT, OCS, SCS, ATC
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Gender | Male
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Dates
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Enumeration Date | 09/27/2011
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Last Update Date | 02/15/2024
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Provider Practice Location Address
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Address Line | 29017 CHARDON RD
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City | WILLOUGHBY HILLS
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State | OH
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Zip | 44092-1475
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Country | US
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Telephone | 440-516-5414
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Fax | 440-516-5197
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Provider Business Mailing Address
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Address Line | 4501 BIRCHWOLD RD
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City | CLEVELAND
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State | OH
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Zip | 44121-4217
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Country | US
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Telephone | 617-680-2195
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Fax | 440-516-5197
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 016194
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number |
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License Number State |
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