Provider Demographics
NPI:1457969974
Name:KOTHE, TESSA (PT)
Entity Type:Individual
Prefix:DR
First Name:TESSA
Middle Name:
Last Name:KOTHE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5747 N ACADEMY BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-3684
Mailing Address - Country:US
Mailing Address - Phone:719-201-4759
Mailing Address - Fax:719-888-1619
Practice Address - Street 1:5747 N ACADEMY BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-3684
Practice Address - Country:US
Practice Address - Phone:719-201-4759
Practice Address - Fax:719-888-1619
Is Sole Proprietor?:No
Enumeration Date:2020-07-21
Last Update Date:2023-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0016970225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist