Provider Demographics
NPI:1558574079
Name:CORRIEA, JOE
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:
Last Name:CORRIEA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 WESTMAR DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-2535
Mailing Address - Country:US
Mailing Address - Phone:585-851-1771
Mailing Address - Fax:585-672-9030
Practice Address - Street 1:53 WESTMAR DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-2535
Practice Address - Country:US
Practice Address - Phone:585-851-1771
Practice Address - Fax:585-672-9030
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022430225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY160743979OtherHOSPITAL TAX ID