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General NPI Number Information
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NPI Number | 1881722775
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Entity Type | Organization
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Legal Business Name | KOTH THERAPY & FITNESS, LLC
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 08/01/2016
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Provider Practice Location Address
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Address Line | 30387 THREE NOTCH ROAD
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City | CHARLOTTE HALL
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State | MD
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Zip | 20622-3183
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Country | US
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Telephone | 301-884-0331
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Fax | 301-472-4388
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Provider Business Mailing Address
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Address Line | PO BOX 398
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City | CHARLOTTE HALL
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State | MD
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Zip | 20622-0398
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Country | US
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Telephone | 301-884-0331
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Fax | 301-472-4388
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Authorized Official
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Title or Position | PT
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Name | CHRISTOPHER R KOTH
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Credential | PT
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Telephone | 301-884-0331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 458R
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License Number State | MD
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