Provider Demographics
NPI:1780845594
Name:VEROSTICK, COREY R (DPT, FAAOMPT)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:R
Last Name:VEROSTICK
Suffix:
Gender:M
Credentials:DPT, FAAOMPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1628 W 11010 S STE 101
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-1278
Mailing Address - Country:US
Mailing Address - Phone:307-363-5801
Mailing Address - Fax:
Practice Address - Street 1:1628 W 11010 S STE 101
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-1278
Practice Address - Country:US
Practice Address - Phone:307-363-5801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12040712-2401225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2106429Medicaid
TX819T68OtherBLUE CROSS BLUE SHIELD
TX819T68OtherBLUE CROSS BLUE SHIELD