MEDICARE: GLENN M KORENKO 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	2012	OH

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

General Provider Information

NPI Number	:	1437121167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLENN M KORENKO PT

Provider Business Mailing Address
First Line	:	11550 OLDE STONE CT
Second Line	:
City	:	CONCORD TWP
State	:	OH
Zip	:	44077-8933
Country	:	US
Telephone Number	:	440-639-1123
Fax Number	:	440-639-1708

Provider Business Practice Location Address
First Line	:	11550 OLDE STONE CT
Second Line	:
City	:	CONCORD TWP
State	:	OH
Zip	:	44077-8933
Country	:	US
Telephone Number	:	440-639-1123
Fax Number	:	440-639-1708

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

Provider Enumeration Date	:	02/06/2006
Last Update Date	:	05/27/2009

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