Individual
KORI KOGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
626 7TH AVE N, TIERRA VERDE, FL 33715-2003
(410) 868-1624
Mailing address
35746 HARPER AVE, CLINTON TWP, MI 48035-3212
(586) 791-9203
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
PTA21833
FL
Other
Enumeration date
09/09/2011
Last updated
09/09/2011
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