Provider Demographics
NPI:1003934779
Name:COTE, STACY M (PT)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:M
Last Name:COTE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:M
Other - Last Name:MITTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:25 LOCUST LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH BERWICK
Mailing Address - State:ME
Mailing Address - Zip Code:03908-2134
Mailing Address - Country:US
Mailing Address - Phone:207-384-5179
Mailing Address - Fax:
Practice Address - Street 1:25 LOCUST LN
Practice Address - Street 2:
Practice Address - City:SOUTH BERWICK
Practice Address - State:ME
Practice Address - Zip Code:03908-2134
Practice Address - Country:US
Practice Address - Phone:207-384-5179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT862225100000X
NH1777225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist