Individual provider Active NPI

Cameron Cottrell, DPT

  • Physical Therapist
  • Jacksonville, FL
National Provider Identifier
1952857047
Registry record updated Aug 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT34536 Issued in FL
Practice address
1036 Dunn Ave
Jacksonville, FL 32218
Phone
(904) 903-5520
Fax
(904) 903-5525
NPI assigned
Aug 29, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT34536 FL Primary
Physical Therapist 225100000X 070022609 IL

Addresses

Primary practice location

1036 Dunn Ave
Jacksonville, FL 32218

Mailing address

1036 Dunn Ave
Jacksonville, FL 32218-6349
Phone (904) 903-5520

Other practice location 1

1036 Dunn Ave
Jacksonville, FL 32218
Phone (904) 903-5520

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT34536FLMDPhysical Therapist
070022609ILMDPhysical Therapist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1472428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565827200000",
    "number": "1952857047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1036 DUNN AVE",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322186349",
            "telephone_number": "904-903-5520",
            "fax_number": "904-903-5525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1036 DUNN AVE",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32218",
            "telephone_number": "904-903-5520",
            "fax_number": "904-903-5525"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1036 Dunn Ave",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "32218",
            "country_code": "US",
            "telephone_number": "904-903-5520",
            "fax_number": "904-903-5525",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COTTRELL",
        "first_name": "CAMERON",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-08-29",
        "last_updated": "2019-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT34536",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070022609",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.