Provider Demographics
NPI:1376089961
Name:CORDING, AVERY (CNIM)
Entity Type:Individual
Prefix:
First Name:AVERY
Middle Name:
Last Name:CORDING
Suffix:
Gender:F
Credentials:CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 E SOUTHLAKE BLVD
Mailing Address - Street 2:150
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6269
Mailing Address - Country:US
Mailing Address - Phone:817-424-0971
Mailing Address - Fax:888-866-4929
Practice Address - Street 1:251 E SOUTHLAKE BLVD
Practice Address - Street 2:150
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6269
Practice Address - Country:US
Practice Address - Phone:817-424-0971
Practice Address - Fax:888-866-4929
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic