Provider Demographics
NPI:1568516052
Name:COTTON, O'REAL (DPT)
Entity Type:Individual
Prefix:MR
First Name:O'REAL
Middle Name:
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:PO BOX 19275
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91319-9275
Mailing Address - Country:US
Mailing Address - Phone:818-710-8901
Mailing Address - Fax:818-306-3525
Practice Address - Street 1:20265 VENTURA BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2550
Practice Address - Country:US
Practice Address - Phone:818-710-8901
Practice Address - Fax:818-306-3525
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33395225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT33395AMedicare PIN
CAWPT33395CMedicare PIN
CAWPT33395BMedicare PIN