Provider Demographics
NPI:1952857047
Name:COTTRELL, CAMERON (DPT)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:
Last Name:COTTRELL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1036 DUNN AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-6349
Mailing Address - Country:US
Mailing Address - Phone:904-903-5520
Mailing Address - Fax:904-903-5525
Practice Address - Street 1:1036 DUNN AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218
Practice Address - Country:US
Practice Address - Phone:904-903-5520
Practice Address - Fax:904-903-5525
Is Sole Proprietor?:No
Enumeration Date:2016-08-29
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT34536225100000X
IL070022609225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist