Active NPI
Corrie Corrie Mangan
- Physical Therapist
- St Simons Island, GA
National Provider Identifier
1538532817
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT011869
- Practice address
- 109 Ashwood Way
Saint Simons Island, GA 31522-5704 - Phone
- (405) 818-7054
- NPI assigned
- Nov 9, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT011869 | GA | Primary |
Addresses
Primary practice location
109 Ashwood Way
Saint Simons Island, GA 31522-5704
Mailing address
109 Ashwood Way
Saint Simons Island, GA 31522-5704
Phone (405) 818-7054
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT011869 | GA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1447027200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1447027200000",
"number": "1538532817",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "109 ASHWOOD WAY",
"city": "SAINT SIMONS ISLAND",
"state": "GA",
"postal_code": "315225704",
"telephone_number": "405-818-7054"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "109 ASHWOOD WAY",
"city": "SAINT SIMONS ISLAND",
"state": "GA",
"postal_code": "315225704",
"telephone_number": "405-818-7054"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANGAN",
"first_name": "CORRIE",
"middle_name": "CORRIE",
"name_prefix": "Ms.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-11-09",
"last_updated": "2015-11-09",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "GA",
"license": "PT011869",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Simons Island, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.