Provider Demographics
NPI:1871954560
Name:COTTEN, JEFFREY NEAL (PTA, AT)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:NEAL
Last Name:COTTEN
Suffix:
Gender:M
Credentials:PTA, AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2354 MACEDONIA RD
Mailing Address - Street 2:
Mailing Address - City:TALLASSEE
Mailing Address - State:AL
Mailing Address - Zip Code:36078-4829
Mailing Address - Country:US
Mailing Address - Phone:334-283-5585
Mailing Address - Fax:
Practice Address - Street 1:560 DEVALL DR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36832-5813
Practice Address - Country:US
Practice Address - Phone:334-844-7616
Practice Address - Fax:334-844-0215
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-09
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1257225200000X
AL7572255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer