Organization
MARY LOU CORCORAN PT, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY LOU CORCORAN PT (PRESIDENT)
(315) 637-4747
Entity
Organization
Contact information
Practice address
6711 TOWPATH RD STE 100, EAST SYRACUSE, NY 13057-9509
(315) 637-4747
(315) 637-6711
Mailing address
6711 TOWPATH RD STE 100, EAST SYRACUSE, NY 13057-9509
(315) 637-4747
(315) 637-6711
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
006344-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
AU96
—
NY
Enumeration date
07/30/2006
Last updated
06/01/2020
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