Provider Demographics
NPI:1467443077
Name:CORSO, DANIEL V (PT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:V
Last Name:CORSO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615B N MAIN STREET EXT
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-1512
Mailing Address - Country:US
Mailing Address - Phone:724-285-5546
Mailing Address - Fax:724-285-3883
Practice Address - Street 1:1615B N MAIN STREET EXT
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-1512
Practice Address - Country:US
Practice Address - Phone:724-285-5546
Practice Address - Fax:724-285-3883
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADAPT000936225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
11260723OtherCAQH
256673OtherHEALTH AMERICA HEALTH ASS
7002323OtherAETNA
PA162724OtherHIGHMARK BCBS
256673OtherHEALTH AMERICA HEALTH ASS