Provider Demographics
NPI:1518122100
Name:COTTON, MICHAEL BRENT (DPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BRENT
Last Name:COTTON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1685 W 2200 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84119-1456
Mailing Address - Country:US
Mailing Address - Phone:801-887-5455
Mailing Address - Fax:801-442-0946
Practice Address - Street 1:1685 W 2200 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84119-1456
Practice Address - Country:US
Practice Address - Phone:801-887-5455
Practice Address - Fax:801-442-0946
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07391225100000X
UT7833639-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist