Provider Demographics
NPI:1700285269
Name:DRVOL, COREY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:
Last Name:DRVOL
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11001 OLD SAINT AUGUSTINE RD
Mailing Address - Street 2:APT 203
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-1079
Mailing Address - Country:US
Mailing Address - Phone:402-305-4832
Mailing Address - Fax:
Practice Address - Street 1:8087 NORMANDY BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32221-6646
Practice Address - Country:US
Practice Address - Phone:904-781-5666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL29467225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist