Provider Demographics
NPI:1043548027
Name:YOCUM, CORRIE IRENE (MSPT)
Entity Type:Individual
Prefix:
First Name:CORRIE
Middle Name:IRENE
Last Name:YOCUM
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:CORRIE
Other - Middle Name:IRENE
Other - Last Name:CANOUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:82 HOUCK HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-6743
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:109 W 9TH ST
Practice Address - Street 2:
Practice Address - City:BERWICK
Practice Address - State:PA
Practice Address - Zip Code:18603-3024
Practice Address - Country:US
Practice Address - Phone:570-759-0389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-02
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT011726L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist