Provider Demographics
NPI:1114362852
Name:COTTRELL, WILLIAM (MSPT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:COTTRELL
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 SE WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1714
Mailing Address - Country:US
Mailing Address - Phone:720-233-5410
Mailing Address - Fax:
Practice Address - Street 1:119 SE WILSON AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1714
Practice Address - Country:US
Practice Address - Phone:720-233-5410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-08
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0007673225100000X
OR5359225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR5359OtherOREGON PT LICENSE
COPTL.0007673OtherNPI