Provider Demographics
NPI:1164886776
Name:SCHALL, CORY THOMAS
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:THOMAS
Last Name:SCHALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 EUCLID AVE # G58
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-2214
Mailing Address - Country:US
Mailing Address - Phone:216-444-3877
Mailing Address - Fax:
Practice Address - Street 1:9500 EUCLID AVE # G58
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-2018
Practice Address - Country:US
Practice Address - Phone:216-444-7360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-09
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program