Provider Demographics
NPI:1386956449
Name:SOUTHERS, COREY (PT, DPT)
Entity type:Individual
Prefix:
First Name:COREY
Middle Name:
Last Name:SOUTHERS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 NORTHRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3324
Mailing Address - Country:US
Mailing Address - Phone:815-901-1198
Mailing Address - Fax:
Practice Address - Street 1:4041 N HIGH ST STE 100A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3248
Practice Address - Country:US
Practice Address - Phone:815-901-1198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-06
Last Update Date:2024-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH013384225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist