Provider Demographics
NPI:1225425986
Name:LIBERA, COREY ELIZABETH SOPHIA
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:ELIZABETH SOPHIA
Last Name:LIBERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6220 W 127TH PL
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-2314
Mailing Address - Country:US
Mailing Address - Phone:708-337-3048
Mailing Address - Fax:
Practice Address - Street 1:6220 W 127TH PL
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-2314
Practice Address - Country:US
Practice Address - Phone:708-337-3048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-21
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer