Healthcare Provider Details

I. General information

NPI: 1659886760
Provider Name (Legal Business Name): AUTUMN COTTER MS,PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2017
Last Update Date: 12/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 OAK LANE AVE
PHILADELPHIA PA
19126-3340
US

IV. Provider business mailing address

253 W PINE ST
AUDUBON NJ
08106-1554
US

V. Phone/Fax

Practice location:
  • Phone: 215-224-9898
  • Fax:
Mailing address:
  • Phone: 609-313-6020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT012442L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: