Provider Demographics
NPI:1316595515
Name:MEAD, CORYANN LEDFORD (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:CORYANN
Middle Name:LEDFORD
Last Name:MEAD
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:DR
Other - First Name:CORYANN
Other - Middle Name:LYN-MARIE
Other - Last Name:LEDFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:2856 E 3365 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-3034
Mailing Address - Country:US
Mailing Address - Phone:619-312-5955
Mailing Address - Fax:
Practice Address - Street 1:100 N MARIO CAPECCHI DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84113-1103
Practice Address - Country:US
Practice Address - Phone:801-662-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-30
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2969962251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics