Provider Demographics
NPI:1104995406
Name:CORA REHABILITATION
Entity type:Organization
Organization Name:CORA REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPY ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOHNNIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PUCCIO
Authorized Official - Suffix:
Authorized Official - Credentials:PTA, LMT
Authorized Official - Phone:561-478-3702
Mailing Address - Street 1:4345 WOODSTOCK DR
Mailing Address - Street 2:UNIT B
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-2602
Mailing Address - Country:US
Mailing Address - Phone:561-371-1151
Mailing Address - Fax:
Practice Address - Street 1:6901 OKEECHOBEE BLVD
Practice Address - Street 2:E2
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-2511
Practice Address - Country:US
Practice Address - Phone:561-478-3702
Practice Address - Fax:561-478-3703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA19316305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization