Provider Demographics
NPI:1245413301
Name:NOTTAGE, EARL (PTA)
Entity Type:Individual
Prefix:
First Name:EARL
Middle Name:
Last Name:NOTTAGE
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 1:10825 SW 152ND TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-1356
Mailing Address - Country:US
Mailing Address - Phone:305-799-8865
Mailing Address - Fax:305-649-3601
Practice Address - Street 1:2115 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-3319
Practice Address - Country:US
Practice Address - Phone:305-649-4616
Practice Address - Fax:305-649-3601
Is Sole Proprietor?:No
Enumeration Date:2007-12-12
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT A011446225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant