Provider Demographics
NPI:1821175548
Name:COTTA, PAUL WILLIAM (PT)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:WILLIAM
Last Name:COTTA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3602 N CHANDLER DR
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:FL
Mailing Address - Zip Code:34442-3758
Mailing Address - Country:US
Mailing Address - Phone:352-342-7144
Mailing Address - Fax:352-419-4664
Practice Address - Street 1:3602 N CHANDLER DR
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:FL
Practice Address - Zip Code:34442-3758
Practice Address - Country:US
Practice Address - Phone:352-342-7144
Practice Address - Fax:352-419-4664
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT16097225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY7841YOtherMEDICARE
FLY8741ZMedicare ID - Type UnspecifiedMEDICARE PT PROVIDER