Active NPI
Simon Corocoto III, PT
- Physical Therapist
- Traverse City, MI
National Provider Identifier
1902221971
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 5501007879
- Practice address
- 3176 Zimmerman Rd
Traverse City, MI 49685-9013 - Phone
- (231) 620-5798
- NPI assigned
- Feb 26, 2014
- Sex
- Male
- 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 | 5501007879 | MI | Primary |
Addresses
Primary practice location
3176 Zimmerman Rd
Traverse City, MI 49685-9013
Mailing address
3176 Zimmerman Rd
Traverse City, MI 49685-9013
Phone (231) 620-5798
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5501007879 | Other | MI | STATE OF MICHIGAN PT LICENSE |
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 |
|---|---|---|---|
| 5501007879 | MI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1393372800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1393372800000",
"number": "1902221971",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3176 ZIMMERMAN RD",
"city": "TRAVERSE CITY",
"state": "MI",
"postal_code": "496859013",
"telephone_number": "231-620-5798"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3176 ZIMMERMAN RD",
"city": "TRAVERSE CITY",
"state": "MI",
"postal_code": "496859013",
"telephone_number": "231-620-5798"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COROCOTO",
"first_name": "SIMON",
"name_suffix": "III",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-02-26",
"last_updated": "2014-02-26",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MI",
"license": "5501007879",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE OF MICHIGAN PT LICENSE",
"identifier": "5501007879",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Traverse City, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.