Provider Demographics
NPI:1124306980
Name:MASTIN, COREY R
Entity type:Individual
Prefix:MR
First Name:COREY
Middle Name:R
Last Name:MASTIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 RYE ST
Mailing Address - Street 2:STE 125
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-6829
Mailing Address - Country:US
Mailing Address - Phone:603-610-2200
Mailing Address - Fax:603-610-2202
Practice Address - Street 1:15 RYE ST
Practice Address - Street 2:STE 125
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-6829
Practice Address - Country:US
Practice Address - Phone:603-610-2200
Practice Address - Fax:603-610-2202
Is Sole Proprietor?:No
Enumeration Date:2011-07-28
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHNH3637225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist