Vicki D Corcoran, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

826-019 Issued in WI

Practice address

421 Camelot Dr
Fond Du Lac, WI 54935

Phone

(920) 923-7940

NPI assigned

Jun 14, 2006

Last updated

Aug 10, 2007By 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 identifiers 1

Other names 1

• Vicki D Johnson 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": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1186704000000",
    "number": "1962445163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "421 CAMELOT DR",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "54935",
            "telephone_number": "920-923-7940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "421 CAMELOT DR",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "54935",
            "telephone_number": "920-923-7940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORCORAN",
        "first_name": "VICKI",
        "middle_name": "D",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-14",
        "last_updated": "2007-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "WI",
            "license": "826-019",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40341000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "VICKI",
            "last_name": "JOHNSON",
            "middle_name": "D",
            "credential": "PTA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Consultants Laboratory of Wisconsin, LLC
• Thomas Miles Cook, LCSW
• Calelle Cooper, PHARMD
• Corbett Chiropractic Care, SC
• Deborah Leah Chagnon Corbett, D.C.
• Cornerstone Caregiving East LLC
• Elizabeth M Cotter, RN
• Lisa Marie Coulter, MS-CCC-SLP
• Carol A Craig, CRNA
• Emily Crego

• Physical Therapy Assistant in Fond Du Lac, WI
• Providers in Fond Du Lac, WI by specialty
• Physical Therapy Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2007; 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.