Healthcare Provider Details

I. General information

NPI: 1104995406
Provider Name (Legal Business Name): CORA REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6901 OKEECHOBEE BLVD E2
WEST PALM BEACH FL
33411-2511
US

IV. Provider business mailing address

4345 WOODSTOCK DR UNIT B
WEST PALM BEACH FL
33409-2602
US

V. Phone/Fax

Practice location:
  • Phone: 561-478-3702
  • Fax: 561-478-3703
Mailing address:
  • Phone: 561-371-1151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License NumberPTA19316
License Number StateFL

VIII. Authorized Official

Name: MRS. JOHNNIE LYNN PUCCIO
Title or Position: PHYSICAL THERAPY ASSISTANT
Credential: PTA, LMT
Phone: 561-478-3702