Provider Demographics
NPI:1811010788
Name:FOX, CORY A (ATC, CSCS)
Entity Type:Individual
Prefix:MR
First Name:CORY
Middle Name:A
Last Name:FOX
Suffix:
Gender:M
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 E FREDERICK AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-2811
Mailing Address - Country:US
Mailing Address - Phone:850-776-7446
Mailing Address - Fax:
Practice Address - Street 1:1000 W BROADWAY ST
Practice Address - Street 2:SUITE 200
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-9260
Practice Address - Country:US
Practice Address - Phone:407-359-4166
Practice Address - Fax:407-359-4241
Is Sole Proprietor?:No
Enumeration Date:2007-04-07
Last Update Date:2010-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 19742255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer