Basic Information
| Provider Information | |||||||||
| NPI: | 1831234350 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CORA HEALTH SERVICES, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 108 FOREVER AVE | ||||||||
| Address2: | |||||||||
| City: | LAKE PLACID | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338528729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8634659500 | ||||||||
| FaxNumber: | 8634659542 | ||||||||
| Practice Location | |||||||||
| Address1: | 204 US 27 S | ||||||||
| Address2: | |||||||||
| City: | LAKE PLACID | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338527900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8634659500 | ||||||||
| FaxNumber: | 8634659542 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2007 | ||||||||
| LastUpdateDate: | 08/08/2008 | ||||||||
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| AuthorizedOfficialLastName: | BOBO | ||||||||
| AuthorizedOfficialFirstName: | TODD | ||||||||
| AuthorizedOfficialMiddleName: | TIMOTHY | ||||||||
| AuthorizedOfficialTitleorPosition: | ATHLETIC TRAINER | ||||||||
| AuthorizedOfficialTelephone: | 8634659500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | ATC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | AL 1131 | FL | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.