Provider Demographics
NPI:1679029177
Name:CAUDLE, COREY (DPT)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:
Last Name:CAUDLE
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 1:3053 MEDICAL CENTER PKWY
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-4185
Mailing Address - Country:US
Mailing Address - Phone:615-848-6401
Mailing Address - Fax:615-907-6315
Practice Address - Street 1:3053 MEDICAL CENTER PKWY
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-4185
Practice Address - Country:US
Practice Address - Phone:615-848-6401
Practice Address - Fax:615-907-6315
Is Sole Proprietor?:No
Enumeration Date:2016-08-25
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN225100000X
SC20000288232255A2300X
390200000X
TN13929225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program