Corryn A Brooks, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

36002662A Issued in IN

Practice address

43 Lake Metonga TRL
Grant Park, IL 60940-9778

Phone

(815) 508-3053

NPI assigned

Aug 2, 2016

Last updated

Dec 2, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Corryn A Poby Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1470096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575244800000",
    "number": "1053864496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43 LAKE METONGA TRL",
            "city": "GRANT PARK",
            "state": "IL",
            "postal_code": "609409778",
            "telephone_number": "815-508-3053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43 LAKE METONGA TRL",
            "city": "GRANT PARK",
            "state": "IL",
            "postal_code": "609409778",
            "telephone_number": "815-508-3053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROOKS",
        "first_name": "CORRYN",
        "middle_name": "A",
        "name_prefix": "Mrs.",
        "credential": "ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-02",
        "last_updated": "2019-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "IN",
            "license": "36002662A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CORRYN",
            "last_name": "POBY",
            "middle_name": "A",
            "credential": "ATC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kristen Berger, CRNA
• Dana Dickson, RPH
• Kathleen Flanagan
• Chris Gnandt, PT, DPT
• Grant Park Community Unit District 6
• Grant Park Fire Protection District

• Athletic Trainer in Grant Park, IL
• Providers in Grant Park, IL by specialty
• Athletic Trainer in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.