Provider Demographics
NPI:1245497874
Name:COTTON, YUKENDRA (LMT)
Entity type:Individual
Prefix:
First Name:YUKENDRA
Middle Name:
Last Name:COTTON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 WIRE RD
Mailing Address - Street 2:
Mailing Address - City:DARLINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29532-3526
Mailing Address - Country:US
Mailing Address - Phone:843-229-6602
Mailing Address - Fax:
Practice Address - Street 1:3203 W PALMETTO ST STE L
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-5900
Practice Address - Country:US
Practice Address - Phone:843-667-3636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5008225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist