Provider Demographics
NPI:1124476031
Name:COOTAUCO, ANNA MARIE FATIMA
Entity type:Individual
Prefix:
First Name:ANNA MARIE FATIMA
Middle Name:
Last Name:COOTAUCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 W SAMPLE RD
Mailing Address - Street 2:APT 206
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-3238
Mailing Address - Country:US
Mailing Address - Phone:954-344-4145
Mailing Address - Fax:
Practice Address - Street 1:1359 E SAMPLE RD
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-6278
Practice Address - Country:US
Practice Address - Phone:954-785-8252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-01
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1274576225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist