Provider Demographics
NPI:1043366263
Name:ANDREWS, CORY (ATC LAT)
Entity Type:Individual
Prefix:MR
First Name:CORY
Middle Name:
Last Name:ANDREWS
Suffix:
Gender:M
Credentials:ATC LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1906 N SANDPIPER DR
Mailing Address - Street 2:APT B
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46582-9021
Mailing Address - Country:US
Mailing Address - Phone:239-405-3059
Mailing Address - Fax:
Practice Address - Street 1:2101 DUBOIS DR
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-3210
Practice Address - Country:US
Practice Address - Phone:574-372-7671
Practice Address - Fax:574-372-7625
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36001293A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer