MEDICARE: AUTUMN COTTER MS,PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT012442L	PA

General Provider Information

NPI Number	:	1659886760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUTUMN COTTER MS,PT

Provider Business Mailing Address
First Line	:	253 W PINE ST
Second Line	:
City	:	AUDUBON
State	:	NJ
Zip	:	08106-1554
Country	:	US
Telephone Number	:	609-313-6020
Fax Number	:

Provider Business Practice Location Address
First Line	:	1020 OAK LANE AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19126-3340
Country	:	US
Telephone Number	:	215-224-9898
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2017
Last Update Date	:	12/12/2017

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