Provider Demographics
NPI:1689254765
Name:DRAKE, CORENE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CORENE
Middle Name:
Last Name:DRAKE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 BROOKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-2323
Mailing Address - Country:US
Mailing Address - Phone:832-704-7928
Mailing Address - Fax:
Practice Address - Street 1:7217 TELECOM PKWY
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75044-2202
Practice Address - Country:US
Practice Address - Phone:972-495-6986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1286467225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist