Healthcare Provider Details

I. General information

NPI: 1548976103
Provider Name (Legal Business Name): COR PHYSICAL THERAPY AND PILATES STUDIO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2023
Last Update Date: 03/19/2023
Certification Date: 03/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3604 VERANDAH DR STE AANDB
AUGUSTA GA
30909-5608
US

IV. Provider business mailing address

2709 BUTLER PL
AUGUSTA GA
30909-3710
US

V. Phone/Fax

Practice location:
  • Phone: 706-250-0081
  • Fax: 762-320-5338
Mailing address:
  • Phone: 706-414-0991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251E1300X
TaxonomyClinical Electrophysiology Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. YOLANDA ABERNATHY
Title or Position: OWNER
Credential:
Phone: 706-414-0991