Provider Demographics
NPI:1255188942
Name:CORK, JOSEPH K (DPT)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:K
Last Name:CORK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3418 W MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-9446
Mailing Address - Country:US
Mailing Address - Phone:662-554-9699
Mailing Address - Fax:662-240-2260
Practice Address - Street 1:3418 W MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-9446
Practice Address - Country:US
Practice Address - Phone:662-554-9699
Practice Address - Fax:662-240-2260
Is Sole Proprietor?:No
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT6706225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist