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NPI Code Detail

MEDICARE: SALLY ABBOTT COTTRELL IV

MEDICARE: SALLY ABBOTT COTTRELL IV
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 TherapistPT21786FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1255523890
Entity Type Code : Individual
Provider Name (Legal Business Name) : SALLY ABBOTT COTTRELL IV
Provider Business Mailing Address
First Line : 394 N SUNCOAST BLVD
Second Line :
City : CRYSTAL RIVER
State : FL
Zip : 34429-5466
Country : US
Telephone Number : 352-795-6225
Fax Number : 352-795-6065
Provider Business Practice Location Address
First Line : 394 N SUNCOAST BLVD
Second Line :
City : CRYSTAL RIVER
State : FL
Zip : 34429-5466
Country : US
Telephone Number : 352-795-6225
Fax Number : 352-795-6065
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/17/2007
Last Update Date : 08/17/2007

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Directions to “ SALLY ABBOTT COTTRELL IV ” Practice Location

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