Provider Demographics
NPI:1245344522
Name:SMITH, COREY TAYLOR (ATC, L)
Entity type:Individual
Prefix:MR
First Name:COREY
Middle Name:TAYLOR
Last Name:SMITH
Suffix:
Gender:M
Credentials:ATC, L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10712 TALLAHASSEE DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-7683
Mailing Address - Country:US
Mailing Address - Phone:214-705-7327
Mailing Address - Fax:
Practice Address - Street 1:1101 OHIO DR
Practice Address - Street 2:SUITE 110
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5330
Practice Address - Country:US
Practice Address - Phone:972-985-2622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT31892255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer