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NPI Code Detail

MEDICARE: BENJAMIN M CORCORAN M.S.,P.T.

MEDICARE: BENJAMIN M CORCORAN M.S.,P.T.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist023544NY
2225100000XPhysical Therapist040-0003806VT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1083609531
Entity Type Code : Individual
Provider Name (Legal Business Name) : BENJAMIN M CORCORAN M.S.,P.T.
Provider Business Mailing Address
First Line : 115 WELLNESS DR
Second Line :
City : WILLISTON
State : VT
Zip : 05495-2088
Country : US
Telephone Number : 802-860-1358
Fax Number : 802-860-1093
Provider Business Practice Location Address
First Line : 115 WELLNESS DR
Second Line :
City : WILLISTON
State : VT
Zip : 05495-2088
Country : US
Telephone Number : 802-860-1358
Fax Number : 802-860-1093
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/12/2005
Last Update Date : 12/06/2012

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