Provider Demographics
NPI:1992822852
Name:CORKILL, EDGAR HENRY (PTA)
Entity Type:Individual
Prefix:MR
First Name:EDGAR
Middle Name:HENRY
Last Name:CORKILL
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:MR
Other - First Name:EDGAR
Other - Middle Name:HENRY
Other - Last Name:CORKILL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1313 MORRIS ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78401-3262
Mailing Address - Country:US
Mailing Address - Phone:361-215-0587
Mailing Address - Fax:
Practice Address - Street 1:2606 HOSPITAL BLVD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78405-1804
Practice Address - Country:US
Practice Address - Phone:361-902-4590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2042802225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant