Individual
BENJAMIN M CORCORAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.S.,P.T.
Contact information
Practice address
115 WELLNESS DR, WILLISTON, VT 05495-2088
(802) 860-1358
(802) 860-1093
Mailing address
115 WELLNESS DR, WILLISTON, VT 05495-2088
(802) 860-1358
(802) 860-1093
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
023544
NY
225100000X
Physical Therapist
Primary
040-0003806
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02278839
—
NY
05
—
1018180
—
VT
Enumeration date
09/12/2005
Last updated
12/06/2012
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