Provider Demographics
NPI:1881648533
Name:CORREA, LUIS RENE' (PT)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:RENE'
Last Name:CORREA
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 1:1368 HAYNER RD
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-7889
Mailing Address - Country:US
Mailing Address - Phone:270-843-1407
Mailing Address - Fax:270-745-1473
Practice Address - Street 1:958 COLLETT AVE
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-2304
Practice Address - Country:US
Practice Address - Phone:270-796-6822
Practice Address - Fax:270-745-1473
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY001367225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist