Provider Demographics
NPI:1962082701
Name:HISLE, CORY (MS, CPT)
Entity type:Individual
Prefix:
First Name:CORY
Middle Name:
Last Name:HISLE
Suffix:
Gender:M
Credentials:MS, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 W NEW RD
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-7304
Mailing Address - Country:US
Mailing Address - Phone:317-468-6252
Mailing Address - Fax:
Practice Address - Street 1:888 W NEW RD
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-7304
Practice Address - Country:US
Practice Address - Phone:317-468-6252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist
No226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist