Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 016194 | OH |
N | 2251S0007X | Physical Therapist - Sports | ||
N | 2251X0800X | Physical Therapist - Orthopedic |
NPI | 1164705059 |
---|---|
Provider Name | Andrew Jeremiah Roth |
First Address | Cleveland, OH 44121-2542 |
Second Address | Willoughby Hills, OH 44092-1475 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2011 |
Last Update Date | 17/03/2018 |