MEDICARE: CORY PAUL PICHOFF PTA

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	225200000X	Physical Therapy Assistant	2022020026	MO

General Provider Information

NPI Number	:	1457177354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORY PAUL PICHOFF PTA

Provider Business Mailing Address
First Line	:	140 TYLER CIR
Second Line	:
City	:	HOLLISTER
State	:	MO
Zip	:	65672-5502
Country	:	US
Telephone Number	:	417-598-0817
Fax Number	:

Provider Business Practice Location Address
First Line	:	16914 STATE HIGHWAY 13
Second Line	:
City	:	REEDS SPRING
State	:	MO
Zip	:	65737-9670
Country	:	US
Telephone Number	:	417-272-3909
Fax Number	:

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

Provider Enumeration Date	:	11/25/2024
Last Update Date	:	11/25/2024

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Directions to “ CORY PAUL PICHOFF PTA” Practice Location

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