Provider Demographics
NPI:1588925697
Name:COTA, KEVIN CHARLES (DPT)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:CHARLES
Last Name:COTA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 402
Mailing Address - Street 2:
Mailing Address - City:COS COB
Mailing Address - State:CT
Mailing Address - Zip Code:06807-0402
Mailing Address - Country:US
Mailing Address - Phone:203-905-9836
Mailing Address - Fax:
Practice Address - Street 1:35 RIVER RD
Practice Address - Street 2:
Practice Address - City:COS COB
Practice Address - State:CT
Practice Address - Zip Code:06807-2759
Practice Address - Country:US
Practice Address - Phone:203-422-0679
Practice Address - Fax:203-422-0913
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT14.009383225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD400079929Medicare PIN