Healthcare Provider Details

I. General information

NPI: 1770357717
Provider Name (Legal Business Name): KAELA COTTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2023
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9901 STARLITE DR
RIVERVIEW FL
33578-3848
US

IV. Provider business mailing address

9901 STARLITE DR
RIVERVIEW FL
33578-3848
US

V. Phone/Fax

Practice location:
  • Phone: 757-310-9456
  • Fax:
Mailing address:
  • Phone: 757-310-9456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL.0019485
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: