MEDICARE: ROSEMARY LEIGH MARSHALL CORLEY PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT005935	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295894657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSEMARY LEIGH MARSHALL CORLEY PT

Provider Business Mailing Address
First Line	:	2741 QUILLIANS DR
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30506-2885
Country	:	US
Telephone Number	:	678-616-3099
Fax Number	:	770-406-6840

Provider Business Practice Location Address
First Line	:	5226 DAHLONEGA HWY
Second Line	:	UNIT 3
City	:	CLERMONT
State	:	GA
Zip	:	30527-1946
Country	:	US
Telephone Number	:	678-616-3099
Fax Number	:	770-406-6840

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2006
Last Update Date	:	09/01/2015

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