Healthcare Provider Details

I. General information

NPI: 1528791696
Provider Name (Legal Business Name): COREY DOYLE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2022
Last Update Date: 07/06/2022
Certification Date: 07/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 RIVER PL STE B
LANSING IL
60438-6038
US

IV. Provider business mailing address

1816 170TH ST
HAZEL CREST IL
60429-1451
US

V. Phone/Fax

Practice location:
  • Phone: 708-895-9860
  • Fax:
Mailing address:
  • Phone: 708-335-1415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: