Provider Demographics
NPI:1104888031
Name:BIRCKBICHLER, CORY MICHAEL (DPT)
Entity type:Individual
Prefix:
First Name:CORY
Middle Name:MICHAEL
Last Name:BIRCKBICHLER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4203 STATE ROUTE 66
Mailing Address - Street 2:SUITE 102
Mailing Address - City:APOLLO
Mailing Address - State:PA
Mailing Address - Zip Code:15613-1532
Mailing Address - Country:US
Mailing Address - Phone:724-727-7915
Mailing Address - Fax:724-727-3936
Practice Address - Street 1:4203 STATE ROUTE 66
Practice Address - Street 2:SUITE 102
Practice Address - City:APOLLO
Practice Address - State:PA
Practice Address - Zip Code:15613-1532
Practice Address - Country:US
Practice Address - Phone:724-727-7915
Practice Address - Fax:724-727-3936
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT015964225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA072904UY6OtherMEDICARE
PA0019666970001Medicaid
PA0019666970001Medicaid