Provider Demographics
NPI:1205172889
Name:LARGE, CORRIE MARTIN (PT, DPT)
Entity type:Individual
Prefix:MS
First Name:CORRIE
Middle Name:MARTIN
Last Name:LARGE
Suffix:
Gender:
Credentials:PT, DPT
Other - Prefix:
Other - First Name:CORRIE
Other - Middle Name:MICHELLE
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2001 BUTTERFIELD RD STE 1600
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1211
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9408 APISON PIKE STE 150
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363
Practice Address - Country:US
Practice Address - Phone:423-396-3004
Practice Address - Fax:423-396-3005
Is Sole Proprietor?:No
Enumeration Date:2012-12-30
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT011068225100000X
TN9489225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist