Provider Demographics
NPI:1811910193
Name:CABLE, CORRIE THOMAS (PT)
Entity type:Individual
Prefix:
First Name:CORRIE
Middle Name:THOMAS
Last Name:CABLE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 TIPTON DR
Mailing Address - Street 2:
Mailing Address - City:DAHLONEGA
Mailing Address - State:GA
Mailing Address - Zip Code:30533-1604
Mailing Address - Country:US
Mailing Address - Phone:706-864-0755
Mailing Address - Fax:070-686-4098
Practice Address - Street 1:111 TIPTON DR
Practice Address - Street 2:
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30533-1604
Practice Address - Country:US
Practice Address - Phone:706-864-0755
Practice Address - Fax:070-686-4098
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT008813225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA116780Medicare ID - Type UnspecifiedFACILITY MEDICARE NUMBER