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General NPI Number Information
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NPI Number | 1942676234
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Entity Type | Individual
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Provider Name | GREGORY CORIELL
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Gender | Male
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Dates
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Enumeration Date | 08/20/2015
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Last Update Date | 08/20/2015
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Provider Practice Location Address
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Address Line | 75 HALE ST
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City | WILMINGTON
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State | OH
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Zip | 45177-2104
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Country | US
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Telephone | 937-382-0667
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Fax |
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Provider Business Mailing Address
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Address Line | 6837 STATE ROUTE 350
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City | CLARKSVILLE
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State | OH
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Zip | 45113-9543
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Country | US
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Telephone | 740-285-2720
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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 | PTA.07559
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License Number State | OH
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