Provider Demographics
NPI:1790744563
Name:TINKLE, COREY WAYNE (MS PT)
Entity Type:Individual
Prefix:MR
First Name:COREY
Middle Name:WAYNE
Last Name:TINKLE
Suffix:
Gender:M
Credentials:MS PT
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Mailing Address - Street 1:17706 I 30
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015
Mailing Address - Country:US
Mailing Address - Phone:501-315-4414
Mailing Address - Fax:501-315-3467
Practice Address - Street 1:17706 I 30
Practice Address - Street 2:SUITE 3
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015
Practice Address - Country:US
Practice Address - Phone:501-315-4414
Practice Address - Fax:501-315-3467
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARPT2069225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5U658OtherBCBS