Provider Demographics
NPI:1679299192
Name:TATOM, CORY LEIGH (PTA)
Entity Type:Individual
Prefix:MS
First Name:CORY
Middle Name:LEIGH
Last Name:TATOM
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W COLLIN RAYE DR SPC 106
Mailing Address - Street 2:
Mailing Address - City:DE QUEEN
Mailing Address - State:AR
Mailing Address - Zip Code:71832-2007
Mailing Address - Country:US
Mailing Address - Phone:870-584-1085
Mailing Address - Fax:870-584-1095
Practice Address - Street 1:300 W COLLIN RAYE DR SPC 106
Practice Address - Street 2:
Practice Address - City:DE QUEEN
Practice Address - State:AR
Practice Address - Zip Code:71832-2007
Practice Address - Country:US
Practice Address - Phone:870-584-1085
Practice Address - Fax:870-584-1095
Is Sole Proprietor?:No
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist