Provider Demographics
NPI:1003253261
Name:MODROWSKI, COREY MATTHEW (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:COREY
Middle Name:MATTHEW
Last Name:MODROWSKI
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3130 CENTRAL PARK W
Mailing Address - Street 2:SUITE A
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43617-1094
Mailing Address - Country:US
Mailing Address - Phone:419-841-9622
Mailing Address - Fax:419-843-8288
Practice Address - Street 1:2332 NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43613-2757
Practice Address - Country:US
Practice Address - Phone:419-290-8094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-29
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT021362225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist