Healthcare Provider Details

I. General information

NPI: 1508502329
Provider Name (Legal Business Name): CORY STOCKER DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2022
Last Update Date: 05/05/2022
Certification Date: 05/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MEDICAL PARK DR
DOVER OH
44622-3204
US

IV. Provider business mailing address

3157 CLOVERHURST ST NE
CANTON OH
44721-2780
US

V. Phone/Fax

Practice location:
  • Phone: 330-602-0719
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT-014906
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: