Provider Demographics
NPI:1326563255
Name:DISBENNETT, CORY (PT, DPT, ATC)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:
Last Name:DISBENNETT
Suffix:
Gender:M
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 PAINTER FORK DR
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:OH
Mailing Address - Zip Code:45106-7811
Mailing Address - Country:US
Mailing Address - Phone:513-876-7230
Mailing Address - Fax:
Practice Address - Street 1:450B WASHINGTON JACKSON RD STE 110
Practice Address - Street 2:
Practice Address - City:EATON
Practice Address - State:OH
Practice Address - Zip Code:45320-7601
Practice Address - Country:US
Practice Address - Phone:513-502-3132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-11
Last Update Date:2017-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT016977225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist