Provider Demographics
NPI:1811187776
Name:NEWMAN, CORY A (PT)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:A
Last Name:NEWMAN
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:PO BOX 21604
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-0162
Mailing Address - Country:US
Mailing Address - Phone:540-725-5300
Mailing Address - Fax:540-725-5356
Practice Address - Street 1:860 OMNI BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4430
Practice Address - Country:US
Practice Address - Phone:757-223-9403
Practice Address - Fax:757-327-0658
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204425225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VADA1361Medicare PIN
VAC08605Medicare PIN
VAP00433959Medicare PIN
VA014761S05Medicare PIN