Healthcare Provider Details

I. General information

NPI: 1134148430
Provider Name (Legal Business Name): JAY E COTTLE PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 N 1000 W
TREMONTON UT
84337-9356
US

IV. Provider business mailing address

PO BOX 25537
SALT LAKE CITY UT
84125-0537
US

V. Phone/Fax

Practice location:
  • Phone: 435-207-4770
  • Fax:
Mailing address:
  • Phone: 435-207-4770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number121211-2401
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: