Provider Demographics
NPI:1649319880
Name:WHARTON, COREY (RPT)
Entity type:Individual
Prefix:
First Name:COREY
Middle Name:
Last Name:WHARTON
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 E HIGHWAY 44
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34429-4444
Mailing Address - Country:US
Mailing Address - Phone:352-563-5055
Mailing Address - Fax:352-563-5069
Practice Address - Street 1:912 E HIGHWAY 44
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-4444
Practice Address - Country:US
Practice Address - Phone:352-563-5055
Practice Address - Fax:352-563-5069
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT8397225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist