Provider Demographics
NPI:1518490127
Name:WAHRER, CORINNE (LMT)
Entity Type:Individual
Prefix:
First Name:CORINNE
Middle Name:
Last Name:WAHRER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:694 LANTANA DR
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-3516
Mailing Address - Country:US
Mailing Address - Phone:817-726-6850
Mailing Address - Fax:
Practice Address - Street 1:1245 HURSTVIEW DR
Practice Address - Street 2:STE 101
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76053-4473
Practice Address - Country:US
Practice Address - Phone:682-557-1879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-10
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX014083225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist