Provider Demographics
NPI:1104829472
Name:KORRELL, GENA R (MPT, CERT, MDT)
Entity Type:Individual
Prefix:
First Name:GENA
Middle Name:R
Last Name:KORRELL
Suffix:
Gender:F
Credentials:MPT, CERT, MDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 CORRINE RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-6781
Mailing Address - Country:US
Mailing Address - Phone:610-793-3514
Mailing Address - Fax:
Practice Address - Street 1:2323 PENNSYLVANIA AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-1332
Practice Address - Country:US
Practice Address - Phone:302-888-2551
Practice Address - Fax:302-888-2571
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ0000744225100000X
PAPT002780E225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE7043347OtherAETNA PROVIDER ID
DEUP1205OtherBCBS PROVIDER ID
DE00B201M97Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID