Provider Demographics
NPI:1710989447
Name:PEED, CORY W (PT)
Entity Type:Individual
Prefix:MR
First Name:CORY
Middle Name:W
Last Name:PEED
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1747 SHAWANO AVE
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54303-3261
Mailing Address - Country:US
Mailing Address - Phone:920-497-3538
Mailing Address - Fax:920-965-1659
Practice Address - Street 1:1747 SHAWANO AVE
Practice Address - Street 2:ADVANCED PHYSICAL THERAPY & SPORTS MEDICINE
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303-3261
Practice Address - Country:US
Practice Address - Phone:920-497-3538
Practice Address - Fax:920-965-1659
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5214225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40272200Medicaid
S67400Medicare UPIN
000386443Medicare ID - Type Unspecified