Provider Demographics
NPI:1184976466
Name:ROTH, ANDREW CHARLES (PTA)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:CHARLES
Last Name:ROTH
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304B NEW LEICESTER HWY
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-2021
Mailing Address - Country:US
Mailing Address - Phone:828-225-3838
Mailing Address - Fax:828-225-3839
Practice Address - Street 1:304B NEW LEICESTER HWY
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-2021
Practice Address - Country:US
Practice Address - Phone:828-225-3838
Practice Address - Fax:828-225-3839
Is Sole Proprietor?:No
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4876225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant