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General NPI Number Information
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NPI Number | 1770907156
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Entity Type | Individual
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Provider Name | COREY NEWTON MA, LAT, ATC
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Gender | Male
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Dates
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Enumeration Date | 02/06/2014
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Last Update Date | 01/26/2017
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Provider Practice Location Address
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Address Line | 940 W 35TH ST
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City | LOS ANGELES
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State | CA
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Zip | 90089-3211
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Country | US
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Telephone | 213-740-6848
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Fax | 213-740-0504
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Provider Business Mailing Address
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Address Line | 10965 BLUFFSIDE DR #157
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City | STUDIO CITY
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State | CA
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Zip | 91604-3330
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Country | US
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Telephone | 903-654-7905
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT5317
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License Number State | TX
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