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Individual
SIMON COROCOTO III
Active
Individual
SIMON COROCOTO III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501007879
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5501007879
STATE OF MICHIGAN PT LICENSE
MI
Enumeration date
02/26/2014
Last updated
02/26/2014
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