Provider Demographics
NPI:1881850782
Name:CARR, CORY BRENDON (PT)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:BRENDON
Last Name:CARR
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2733 E BATTLEFIELD ST
Mailing Address - Street 2:#205
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-3981
Mailing Address - Country:US
Mailing Address - Phone:417-766-6037
Mailing Address - Fax:417-865-4860
Practice Address - Street 1:1602 E REPUBLIC RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-6509
Practice Address - Country:US
Practice Address - Phone:417-766-6037
Practice Address - Fax:417-865-4860
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-31
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001016929225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist