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General NPI Number Information
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NPI Number | 1700989761
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Entity Type | Individual
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Provider Name | COREY MATHEW SOBECK PT
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Gender | Male
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Dates
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Enumeration Date | 09/06/2006
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Last Update Date | 10/08/2008
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Provider Practice Location Address
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Address Line | 1175 WILSON AVE NW
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City | GRAND RAPIDS
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State | MI
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Zip | 49534-3493
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Country | US
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Telephone | 616-284-3686
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Fax | 616-301-1984
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Provider Business Mailing Address
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Address Line | 11794 8TH AVE NW
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City | GRAND RAPIDS
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State | MI
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Zip | 49534
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Country | US
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Telephone | 616-677-5432
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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 | 5501011221
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License Number State | MI
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