Provider Demographics
NPI:1801077664
Name:COGHILL, CAMERON (PT)
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:
Last Name:COGHILL
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 1:5050 CENTRAL SARASOTA PKWY APT 305
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238-7604
Mailing Address - Country:US
Mailing Address - Phone:941-250-5559
Mailing Address - Fax:
Practice Address - Street 1:1303 N TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-2432
Practice Address - Country:US
Practice Address - Phone:941-953-6949
Practice Address - Fax:941-954-5827
Is Sole Proprietor?:No
Enumeration Date:2007-11-21
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT34681225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT23578OtherLICENSE