Provider Demographics
NPI:1972954667
Name:BLOCK, COREY (PT, DPT, CSCS)
Entity type:Individual
Prefix:
First Name:COREY
Middle Name:
Last Name:BLOCK
Suffix:
Gender:F
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 SCIENCE DR
Mailing Address - Street 2:MAIL STOP 9150
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-1074
Mailing Address - Country:US
Mailing Address - Phone:608-266-6071
Mailing Address - Fax:608-890-8568
Practice Address - Street 1:621 SCIENCE DR
Practice Address - Street 2:MAIL STOP 9150
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-1074
Practice Address - Country:US
Practice Address - Phone:608-266-6071
Practice Address - Fax:608-890-8568
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-24
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13506 - 24225100000X
MI5501017753225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist