Individual
MR. CORY WIRT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, MS PT, TPI-CGFI
Contact information
Practice address
6049 HARBOUR PARK DRIVE, MIDLOTHIAN, VA 23112
(804) 639-2359
(804) 639-2029
Mailing address
771 PILOT HOUSE DR, SUITE A, NEWPORT NEWS, VA 23606-1990
(757) 873-2302
(757) 873-2306
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305202875
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010157692
—
VA
01
—
192944
BCBS PHYSICAL THERAPY
VA
01
—
3909474
AETNA
—
01
—
P00398183
RAILROAD MEDICARE
VA
Enumeration date
04/11/2006
Last updated
10/27/2014
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