Provider Demographics
NPI:1831234350
Name:CORA HEALTH SERVICES, INC
Entity type:Organization
Organization Name:CORA HEALTH SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATHLETIC TRAINER
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:TIMOTHY
Authorized Official - Last Name:BOBO
Authorized Official - Suffix:
Authorized Official - Credentials:ATC
Authorized Official - Phone:863-465-9500
Mailing Address - Street 1:108 FOREVER AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE PLACID
Mailing Address - State:FL
Mailing Address - Zip Code:33852-8729
Mailing Address - Country:US
Mailing Address - Phone:863-465-9500
Mailing Address - Fax:863-465-9542
Practice Address - Street 1:204 US 27 S
Practice Address - Street 2:
Practice Address - City:LAKE PLACID
Practice Address - State:FL
Practice Address - Zip Code:33852-7900
Practice Address - Country:US
Practice Address - Phone:863-465-9500
Practice Address - Fax:863-465-9542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 11312255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty