Provider Demographics
NPI:1851545149
Name:COREY-JOHN, MONICA GENENE (PT)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:GENENE
Last Name:COREY-JOHN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 MARJORIE LN
Mailing Address - Street 2:
Mailing Address - City:HILTON
Mailing Address - State:NY
Mailing Address - Zip Code:14468-9797
Mailing Address - Country:US
Mailing Address - Phone:585-747-5792
Mailing Address - Fax:585-392-6530
Practice Address - Street 1:29 MARJORIE LN
Practice Address - Street 2:
Practice Address - City:HILTON
Practice Address - State:NY
Practice Address - Zip Code:14468-9797
Practice Address - Country:US
Practice Address - Phone:585-747-5792
Practice Address - Fax:585-392-6530
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-12
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9589-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist