Provider Demographics
NPI:1497300727
Name:CORRAO, ANTHONY I (ATC)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:CORRAO
Suffix:I
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 WASHINGTON BLVD APT 224
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-5455
Mailing Address - Country:US
Mailing Address - Phone:502-693-4878
Mailing Address - Fax:
Practice Address - Street 1:333 WASHINGTON BLVD APT 224
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-5455
Practice Address - Country:US
Practice Address - Phone:502-693-4878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-04
Last Update Date:2019-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20000338212255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer