Individual
DR. KENNETH JOSEPH CORCORAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT, SCS
Contact information
Practice address
2826 RANDOLPH RD, CHARLOTTE, NC 28211-1386
(716) 830-4866
Mailing address
PO BOX 12512, CHARLOTTE, NC 28220-2512
(716) 830-4866
Taxonomy
Speciality
Code
Description
License number
State
2251S0007X
Sports Physical Therapist
029027-1
NY
2251S0007X
Sports Physical Therapist
Primary
18323
NC
2251S0007X
Sports Physical Therapist
40QA01368400
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
029027-1
LICENSE NUMBER
NY
01
—
18323
LICENSE NUMBER
NC
01
—
40QA01368400
LICENSE NUMBER
NJ
Enumeration date
05/21/2007
Last updated
09/20/2018
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