Provider Demographics
NPI:1912129529
Name:COTTER, SHANE (LMT)
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:
Last Name:COTTER
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2628 SW 31ST TER
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-1721
Mailing Address - Country:US
Mailing Address - Phone:352-216-3895
Mailing Address - Fax:352-401-0081
Practice Address - Street 1:COMPASS HEALTH AND FITNESS
Practice Address - Street 2:524 S. PINE AVE.
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474
Practice Address - Country:US
Practice Address - Phone:352-401-0377
Practice Address - Fax:352-401-0081
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA21444225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist