Basic Information
| Provider Information | |||||||||
| NPI: | 1023485703 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CORKER | ||||||||
| FirstName: | TIMOTHY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1161 MCDERMOTT DR | ||||||||
| Address2: | |||||||||
| City: | WEST CHESTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193804064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4843569401 | ||||||||
| FaxNumber: | 4843569405 | ||||||||
| Practice Location | |||||||||
| Address1: | 1161 MCDERMOTT DR | ||||||||
| Address2: | |||||||||
| City: | WEST CHESTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193804064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4843569401 | ||||||||
| FaxNumber: | 4843569405 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2015 | ||||||||
| LastUpdateDate: | 08/28/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT024471 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.