Provider Demographics
NPI:1053162693
Name:COTTO, JUSTIN (PT, DPT, IADN CERT)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:COTTO
Suffix:
Gender:M
Credentials:PT, DPT, IADN CERT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1251 CANDLELIGHT BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34601-3009
Mailing Address - Country:US
Mailing Address - Phone:352-346-2461
Mailing Address - Fax:
Practice Address - Street 1:1251 CANDLELIGHT BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-3009
Practice Address - Country:US
Practice Address - Phone:352-346-2461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT39935225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist