Provider Demographics
NPI:1922051945
Name:CORN, MATTHEW (DPT)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:CORN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 WHISPERING LN
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-6449
Mailing Address - Country:US
Mailing Address - Phone:941-451-6607
Mailing Address - Fax:941-451-2028
Practice Address - Street 1:1978 TAMIAMI TRL S
Practice Address - Street 2:SUITES 5 & 6
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-5006
Practice Address - Country:US
Practice Address - Phone:941-451-6607
Practice Address - Fax:941-451-2028
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21464225100000X
FLPT214642251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00226835OtherRAILROAD MEDICARE
FLY915KOtherBLUE CROSS BLUE SHIELD FL
ORR152991OtherMEDICARE / OR
FLY915KOtherBLUE CROSS BLUE SHIELD FL
OR500617633OtherMEDICAID / DMAP (OR)