Provider Demographics
NPI:1265856025
Name:KORTHOFF, ROBERT (PT,DPT,CERT MDT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:KORTHOFF
Suffix:
Gender:M
Credentials:PT,DPT,CERT MDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3855 SHALLOWFORD RD
Mailing Address - Street 2:SUITE 415
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-4195
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3855 SHALLOWFORD RD
Practice Address - Street 2:SUITE 415
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-4195
Practice Address - Country:US
Practice Address - Phone:770-420-1122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT010104225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist