Provider Demographics
NPI:1659036457
Name:COTTA, MEGAN JANIS (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:JANIS
Last Name:COTTA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 ANGELA CIR
Mailing Address - Street 2:
Mailing Address - City:HAZLET
Mailing Address - State:NJ
Mailing Address - Zip Code:07730-2453
Mailing Address - Country:US
Mailing Address - Phone:908-433-6079
Mailing Address - Fax:
Practice Address - Street 1:1540 W PARK AVE STE 4
Practice Address - Street 2:
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-3192
Practice Address - Country:US
Practice Address - Phone:732-544-0011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-05
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02056100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist