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NPI Code Detail

MEDICARE: JACOB COTTLE DPT

MEDICARE: JACOB COTTLE DPT
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
1225100000XPhysical Therapist306398CA

General Provider Information

NPI Number : 1205667136
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACOB COTTLE DPT
Provider Business Mailing Address
First Line : 22521 AVENIDA EMPRESA STE 117
Second Line :
City : RANCHO SANTA MARGARITA
State : CA
Zip : 92688-2046
Country : US
Telephone Number : 949-766-8535
Fax Number :
Provider Business Practice Location Address
First Line : 22521 AVENIDA EMPRESA STE 117
Second Line :
City : RANCHO SANTA MARGARITA
State : CA
Zip : 92688-2046
Country : US
Telephone Number : 949-766-8535
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/12/2024
Last Update Date : 08/12/2024

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Directions to “ JACOB COTTLE DPT” Practice Location

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