Kenneth Joseph Corcoran, PT, DPT, SCS

Primary specialty

Sports Physical TherapistTaxonomy code 2251S0007X

License

18323 Issued in NC

Practice address

2826 Randolph Rd
Charlotte, NC 28211-1386

Phone

(716) 830-4866

NPI assigned

May 21, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Activade LLC

  • Physical Therapist
  • Charlotte, NC
  • NPI 1003521089
  NPD Authorized official
• Fusion Physical Therapy and Sports Wellness P.C.

  • Physical Therapist
  • New York, NY
  • NPI 1316927627

  Sports

  NPD
• Matrix Rehabilitation South Carolina, Inc.

  • Rehabilitation Clinic/Center
  • Greenville, SC
  • NPI 1023034048
  NPD (past)

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

{
    "created_epoch": "1179705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537401600000",
    "number": "1508075334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 12512",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282202512",
            "telephone_number": "716-830-4866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2826 RANDOLPH RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282111386",
            "telephone_number": "716-830-4866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORCORAN",
        "first_name": "KENNETH",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "PT, DPT, SCS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-21",
        "last_updated": "2018-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251S0007X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Sports",
            "state": "NY",
            "license": "029027-1",
            "primary": false
        },
        {
            "code": "2251S0007X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Sports",
            "state": "NJ",
            "license": "40QA01368400",
            "primary": false
        },
        {
            "code": "2251S0007X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Sports",
            "state": "NC",
            "license": "18323",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "40QA01368400",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "029027-1",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "18323",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sarah R Corbin, PT
• Lauren Elizabeth Corbley
• Nicole Ashley Corbo, MA, CCC-SLP
• Kathleen Wagner Corby, OTR/L
• Brendan Michael Corcoran
• Susan Klimas Corcoran, OTR/L
• Paige Hull Cordek, PT, DPT
• Deborah Leigh Cordell, LPC, MFT-A
• Miranda Cordell, MD
• Leslie Holmes Cordero, DPT

• All providers in Charlotte, NC
• Sports Physical Therapist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2018; 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.