Provider Demographics
NPI:1801113840
Name:URBANSKI, COREY B (PT)
Entity type:Individual
Prefix:
First Name:COREY
Middle Name:B
Last Name:URBANSKI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3322 WINDY FOREST LN
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-7382
Mailing Address - Country:US
Mailing Address - Phone:614-406-4622
Mailing Address - Fax:
Practice Address - Street 1:7720 RIVERS EDGE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-1361
Practice Address - Country:US
Practice Address - Phone:614-406-4622
Practice Address - Fax:614-389-2078
Is Sole Proprietor?:No
Enumeration Date:2010-04-30
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT0096872251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3059005Medicaid
OH3059005Medicaid