Provider Demographics
NPI:1770833592
Name:ARTH, CORY CHRISTOPHER (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:CHRISTOPHER
Last Name:ARTH
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15862 GLENSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-1304
Mailing Address - Country:US
Mailing Address - Phone:530-277-0171
Mailing Address - Fax:
Practice Address - Street 1:18400 AVALON BLVD
Practice Address - Street 2:SUITE 800
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-2172
Practice Address - Country:US
Practice Address - Phone:310-630-2290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39403225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist