Provider Demographics
NPI:1053529503
Name:FEDOR, COREY PAUL (PT)
Entity type:Individual
Prefix:MR
First Name:COREY
Middle Name:PAUL
Last Name:FEDOR
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4826 AVELLINO DR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16510-4024
Mailing Address - Country:US
Mailing Address - Phone:814-825-2174
Mailing Address - Fax:
Practice Address - Street 1:2301 EDINBORO RD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-3409
Practice Address - Country:US
Practice Address - Phone:814-860-7117
Practice Address - Fax:814-860-7157
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT012994L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist