Provider Demographics
NPI:1730661844
Name:CORRIGAN, NICK RICHARD
Entity Type:Individual
Prefix:
First Name:NICK
Middle Name:RICHARD
Last Name:CORRIGAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 598
Mailing Address - Street 2:
Mailing Address - City:GREEN RIVER
Mailing Address - State:UT
Mailing Address - Zip Code:84525-0598
Mailing Address - Country:US
Mailing Address - Phone:970-683-1237
Mailing Address - Fax:
Practice Address - Street 1:4585 FILLMORE AVE
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-3172
Practice Address - Country:US
Practice Address - Phone:970-683-1237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer