Provider Demographics
NPI:1699926477
Name:HERSHBERGER, COREY L (MPT)
Entity type:Individual
Prefix:
First Name:COREY
Middle Name:L
Last Name:HERSHBERGER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:COREY
Other - Middle Name:L
Other - Last Name:HUTCHISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:
Practice Address - Street 1:200 PATEWOOD DR
Practice Address - Street 2:STE C150
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3593
Practice Address - Country:US
Practice Address - Phone:864-454-0904
Practice Address - Fax:864-454-0905
Is Sole Proprietor?:No
Enumeration Date:2008-10-09
Last Update Date:2017-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4965225100000X
PAPT015257225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist