MEDICARE: CORENE DRAKE 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	1286467	TX

General Provider Information

NPI Number	:	1689254765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORENE DRAKE PT, DPT

Provider Business Mailing Address
First Line	:	1004 BROOKVIEW DR
Second Line	:
City	:	ALLEN
State	:	TX
Zip	:	75002-2323
Country	:	US
Telephone Number	:	832-704-7928
Fax Number	:

Provider Business Practice Location Address
First Line	:	7217 TELECOM PKWY
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75044-2202
Country	:	US
Telephone Number	:	972-495-6986
Fax Number	:

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

Provider Enumeration Date	:	04/12/2021
Last Update Date	:	04/12/2021

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