Provider Demographics
NPI:1306964796
Name:CORKISH, DANIEL (PT)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:CORKISH
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:PO BOX 816
Mailing Address - Street 2:
Mailing Address - City:MILLBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94030-0816
Mailing Address - Country:US
Mailing Address - Phone:650-652-2376
Mailing Address - Fax:650-652-9097
Practice Address - Street 1:1860 EL CAMINO REAL
Practice Address - Street 2:STE 420
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3117
Practice Address - Country:US
Practice Address - Phone:650-697-2376
Practice Address - Fax:650-697-2374
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT302782251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT30278OtherPT LICENSE
CAPT30278OtherPT LICENSE