Healthcare Provider Details

I. General information

NPI: 1639084122
Provider Name (Legal Business Name): ALEXIS JANAE COTTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1062 W MERCURY BLVD STE 1062
HAMPTON VA
23666-1068
US

IV. Provider business mailing address

1720 PIAZZA PL
HAMPTON VA
23666-2981
US

V. Phone/Fax

Practice location:
  • Phone: 757-644-0644
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number2305217943
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: