Provider Demographics
NPI:1568903060
Name:CINICOLA, COREY (DPT)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:
Last Name:CINICOLA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 HIGH VIEW LN
Mailing Address - Street 2:
Mailing Address - City:MERTZTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19539-9729
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:43 HIGH VIEW LN
Practice Address - Street 2:
Practice Address - City:MERTZTOWN
Practice Address - State:PA
Practice Address - Zip Code:19539-9729
Practice Address - Country:US
Practice Address - Phone:570-650-3346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT025233208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation