Provider Demographics
NPI:1306920715
Name:HEALY, CORY JAMES (PT)
Entity type:Individual
Prefix:MR
First Name:CORY
Middle Name:JAMES
Last Name:HEALY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:NORTH SPRINGFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05150-9751
Mailing Address - Country:US
Mailing Address - Phone:802-886-2321
Mailing Address - Fax:802-886-2567
Practice Address - Street 1:43 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:NORTH SPRINGFIELD
Practice Address - State:VT
Practice Address - Zip Code:05150-9751
Practice Address - Country:US
Practice Address - Phone:802-886-2321
Practice Address - Fax:802-886-2567
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0400002586208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH08Y002458VT01OtherANTHEM BCNH
VT43909OtherMOHAWK VALLEY PLAN
212102OtherCIGNA
VT43909OtherMOHAWK VALLEY PLAN