Provider Demographics
NPI:1699885251
Name:HARDIN, CORIE
Entity type:Individual
Prefix:
First Name:CORIE
Middle Name:
Last Name:HARDIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12935 SHELBYVILLE RD STE 106
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-1592
Mailing Address - Country:US
Mailing Address - Phone:502-489-5002
Mailing Address - Fax:502-489-8002
Practice Address - Street 1:12935 SHELBYVILLE RD STE 106
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-1592
Practice Address - Country:US
Practice Address - Phone:502-489-5002
Practice Address - Fax:502-489-8002
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYA 02294OtherPTA LISCENSE