Provider Demographics
NPI:1609467521
Name:COREA, LAUREL (DPT)
Entity Type:Individual
Prefix:DR
First Name:LAUREL
Middle Name:
Last Name:COREA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 THORNE ST
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-4230
Mailing Address - Country:US
Mailing Address - Phone:631-375-9655
Mailing Address - Fax:
Practice Address - Street 1:430 SILLS ROAD
Practice Address - Street 2:
Practice Address - City:YAPHANK
Practice Address - State:NY
Practice Address - Zip Code:11980-1198
Practice Address - Country:US
Practice Address - Phone:631-924-5583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046664225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist