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General NPI Number Information
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NPI Number | 1720266919
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Entity Type | Organization
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Legal Business Name | UNITED HEALTH ADVISORY GROUP
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Dates
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Enumeration Date | 02/10/2008
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Last Update Date | 08/25/2010
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Provider Practice Location Address
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Address Line | 15148 WILLOW LN
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City | TAVARES
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State | FL
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Zip | 32778-9351
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Country | US
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Telephone | 352-342-7144
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Fax |
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Provider Business Mailing Address
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Address Line | 15148 WILLOW LN
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City | TAVARES
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State | FL
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Zip | 32778-9351
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Country | US
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Telephone | 352-342-7144
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PAUL WILLIAM COTTA
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Credential | PT
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Telephone | 352-342-7144
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 0016097
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License Number State | FL
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