Provider Demographics
NPI:1457618142
Name:CORRIE, SUMMER (LMT)
Entity type:Individual
Prefix:MS
First Name:SUMMER
Middle Name:
Last Name:CORRIE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3011 ROUTE 44 55
Mailing Address - Street 2:APT 9
Mailing Address - City:GARDINER
Mailing Address - State:NY
Mailing Address - Zip Code:12525-5053
Mailing Address - Country:US
Mailing Address - Phone:845-633-0099
Mailing Address - Fax:
Practice Address - Street 1:291 WALL ST
Practice Address - Street 2:SUITE 2A
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-3849
Practice Address - Country:US
Practice Address - Phone:845-633-0099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020208-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist