Provider Demographics
NPI:1255048740
Name:TEMPLE, COREY ELIZABETH
Entity type:Individual
Prefix:
First Name:COREY
Middle Name:ELIZABETH
Last Name:TEMPLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2396 EARLMONT RD
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-1838
Mailing Address - Country:US
Mailing Address - Phone:248-672-9226
Mailing Address - Fax:
Practice Address - Street 1:2605 W 14 MILE RD STE 130
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-1710
Practice Address - Country:US
Practice Address - Phone:248-513-3003
Practice Address - Fax:248-513-3004
Is Sole Proprietor?:No
Enumeration Date:2022-11-03
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501302002225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist