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General NPI Number Information
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NPI Number | 1740064021
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Entity Type | Individual
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Provider Name | CORY R CORCORAN
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Gender | Female
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Dates
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Enumeration Date | 08/21/2023
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Last Update Date | 08/21/2023
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Provider Practice Location Address
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Address Line | 10133 SHERRILL BLVD
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City | KNOXVILLE
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State | TN
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Zip | 37932-3347
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Country | US
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Telephone | 865-210-8374
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Fax |
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Provider Business Mailing Address
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Address Line | 8104 SPRINGTREE RD
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City | JACKSONVILLE
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State | FL
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Zip | 32210-4536
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Country | US
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Telephone | 904-568-4182
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 40QB00323800
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License Number State | NJ
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