Basic Information
| Provider Information | |||||||||
| NPI: | 1700920733 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COTSENMOYER | ||||||||
| FirstName: | STACEY COTSENMOYER | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PTA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ALLISON | ||||||||
| OtherFirstName: | STACEY | ||||||||
| OtherMiddleName: | LEE | ||||||||
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| OtherCredential: | PTA | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 11 LIVE OAK AVE | ||||||||
| Address2: | |||||||||
| City: | YALAHA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347973031 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 600 NORTH BLVD. WEST LAKE CENTRE FOR REHABILITATION | ||||||||
| Address2: | |||||||||
| City: | LEESBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 34748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527286636 | ||||||||
| FaxNumber: | 3527874522 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | PTA12538 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.