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General NPI Number Information
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NPI Number | 1609142991
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Entity Type | Individual
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Provider Name | SCOTT MICHAEL CORLEY PT
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Gender | Male
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Dates
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Enumeration Date | 03/30/2012
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Last Update Date | 03/30/2012
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Provider Practice Location Address
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Address Line | 175 S UNION BLVD SUITE 320
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City | COLORADO SPRINGS
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State | CO
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Zip | 80910-3113
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Country | US
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Telephone | 719-365-1585
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Fax |
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Provider Business Mailing Address
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Address Line | 8164 SE CROFT CIR B5
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City | HOBE SOUND
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State | FL
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Zip | 33455-6340
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Country | US
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Telephone | 863-944-1208
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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 | 11580
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License Number State | CO
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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 | 25852
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License Number State | FL
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