Provider Demographics
NPI:1437252210
Name:HUITT, CORA TYSON (MA, PT)
Entity Type:Individual
Prefix:MRS
First Name:CORA
Middle Name:TYSON
Last Name:HUITT
Suffix:
Gender:F
Credentials:MA, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 CLARKE RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-1622
Mailing Address - Country:US
Mailing Address - Phone:804-213-0082
Mailing Address - Fax:804-213-0528
Practice Address - Street 1:1919 HUGUENOT RD
Practice Address - Street 2:SUITE 202
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-4321
Practice Address - Country:US
Practice Address - Phone:804-379-3002
Practice Address - Fax:804-379-3053
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305001184225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA192292OtherANTHEM PROVIDER NUMBER
VA2305001184OtherPHYSICAL THERAPY LICENSE