MEDICARE: ANNA MARIE FATIMA COOTAUCO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1274576	TX

General Provider Information

NPI Number	:	1124476031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA MARIE FATIMA COOTAUCO

Provider Business Mailing Address
First Line	:	5800 W SAMPLE RD
Second Line	:	APT 206
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-3238
Country	:	US
Telephone Number	:	954-344-4145
Fax Number	:

Provider Business Practice Location Address
First Line	:	1359 E SAMPLE RD
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33064-6278
Country	:	US
Telephone Number	:	954-785-8252
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2016
Last Update Date	:	06/01/2016

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