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General NPI Number Information
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NPI Number | 1477858421
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Entity Type | Organization
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Legal Business Name | CORVIC GROUP
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Dates
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Enumeration Date | 01/24/2011
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Last Update Date | 01/24/2011
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Provider Practice Location Address
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Address Line | 107 PEACOCK DR
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City | WARNER ROBINS
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State | GA
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Zip | 31088-3637
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Country | US
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Telephone | 478-919-6835
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Fax |
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Provider Business Mailing Address
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Address Line | 102 WOODEN EAGLE TRL
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City | KATHLEEN
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State | GA
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Zip | 31047-4137
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Country | US
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Telephone | 478-919-6835
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Fax |
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Authorized Official
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Title or Position | BUSINESS MANAGER/DIRECTOR
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Name | SIMON VICTOR WATSON
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Credential |
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Telephone | 478-919-6835
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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