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General NPI Number Information
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NPI Number | 1023614310
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Entity Type | Individual
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Provider Name | COREY TULLEY
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Gender | Male
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Dates
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Enumeration Date | 12/10/2020
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | 1655 SE WALTON RD
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34952-7657
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Country | US
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Telephone | 772-337-1333
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Fax |
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Provider Business Mailing Address
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Address Line | 53 BRIGHAM AVE
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City | DRACUT
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State | MA
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Zip | 01826-5713
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 39963
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 23261
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License Number State | MA
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