Provider Demographics
NPI:1609014893
Name:CORE PHYSICAL THERAPY & SPORTS MEDICINE PC
Entity Type:Organization
Organization Name:CORE PHYSICAL THERAPY & SPORTS MEDICINE PC
Other - Org Name:CORE MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:TUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-378-1593
Mailing Address - Street 1:3180 MAIN ST
Mailing Address - Street 2:STE 303, 304
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-4237
Mailing Address - Country:US
Mailing Address - Phone:203-373-1593
Mailing Address - Fax:203-549-0899
Practice Address - Street 1:3180 MAIN ST
Practice Address - Street 2:STE 303, 304
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-4237
Practice Address - Country:US
Practice Address - Phone:203-373-1593
Practice Address - Fax:203-549-0899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-27
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy