Provider Demographics
NPI:1700920733
Name:COTSENMOYER, STACEY COTSENMOYER LEE (PTA)
Entity Type:Individual
Prefix:
First Name:STACEY COTSENMOYER
Middle Name:LEE
Last Name:COTSENMOYER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:LEE
Other - Last Name:ALLISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:11 LIVE OAK AVE
Mailing Address - Street 2:
Mailing Address - City:YALAHA
Mailing Address - State:FL
Mailing Address - Zip Code:34797-3031
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 NORTH BLVD. WEST LAKE CENTRE FOR REHABILITATION
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748
Practice Address - Country:US
Practice Address - Phone:352-728-6636
Practice Address - Fax:352-787-4522
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA12538225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant