MEDICARE: COREY SOUTHERS PT, DPT

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	013384	OH

General Provider Information

NPI Number	:	1386956449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COREY SOUTHERS PT, DPT

Provider Business Mailing Address
First Line	:	80 NORTHRIDGE RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43214-3324
Country	:	US
Telephone Number	:	815-901-1198
Fax Number	:

Provider Business Practice Location Address
First Line	:	4041 N HIGH ST STE 100A
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43214-3248
Country	:	US
Telephone Number	:	815-901-1198
Fax Number	:

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

Provider Enumeration Date	:	07/06/2010
Last Update Date	:	11/02/2024

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