Healthcare Provider Details

I. General information

NPI: 1508228271
Provider Name (Legal Business Name): CORY RAYMOND HEGARTY DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 03/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 HOLCOMB BLVD STE 2A
OCEAN SPRINGS MS
39564-3903
US

IV. Provider business mailing address

900 HOLCOMB BLVD STE 2A
OCEAN SPRINGS MS
39564-3903
US

V. Phone/Fax

Practice location:
  • Phone: 228-872-6821
  • Fax: 228-872-6891
Mailing address:
  • Phone: 228-872-6821
  • Fax: 228-872-6891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT5910
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: