Provider Demographics
NPI:1871486001
Name:CORLEY, EDWARD A (ATC)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:A
Last Name:CORLEY
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:EDDIE
Other - Middle Name:A
Other - Last Name:CORLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6207 ORCHID FIELD CT
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-2197
Mailing Address - Country:US
Mailing Address - Phone:661-599-5773
Mailing Address - Fax:
Practice Address - Street 1:6207 ORCHID FIELD CT
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-2197
Practice Address - Country:US
Practice Address - Phone:661-599-5773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-29
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty