Healthcare Provider Details

I. General information

NPI: 1093184269
Provider Name (Legal Business Name): CORA REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2015
Last Update Date: 09/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 6TH ST SE SUITE B
WINTER HAVEN FL
33880-4605
US

IV. Provider business mailing address

1601 6TH ST SE SUITE B
WINTER HAVEN FL
33880-4605
US

V. Phone/Fax

Practice location:
  • Phone: 863-294-0350
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPTA26014
License Number StateFL

VIII. Authorized Official

Name: MRS. DENISE OVERLOCK
Title or Position: CLINIC MANAGER
Credential: PTA
Phone: 863-294-0350