Provider Demographics
NPI:1003163775
Name:ANDREW COTHAM PHYSICAL THERAPY P.C.
Entity Type:Organization
Organization Name:ANDREW COTHAM PHYSICAL THERAPY P.C.
Other - Org Name:OUTBACK REHAB INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PREIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:COTHAM
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:323-401-1935
Mailing Address - Street 1:3311 CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-3133
Mailing Address - Country:US
Mailing Address - Phone:323-401-1935
Mailing Address - Fax:
Practice Address - Street 1:50 ALESSANDRO PL
Practice Address - Street 2:SUITE A40
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3149
Practice Address - Country:US
Practice Address - Phone:323-401-1935
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-12
Last Update Date:2012-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy