| Doctor Name: | MR. COREY THOMAS LONG |
| NPI Number: | 1861460511 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PT |
| License Number: | 1115061 |
| Business Practice Address: | 100 W Southlake Blvd Ste 420 Southlake, TX - 76092 |
| Business Phone Number: | 8174428600 |
| Business Fax Number: | 8174428603 |
| Mailing Address: | 2037 Terence Lane, LEWISVILLE |
| State: | TX |
| Postal Code: | 75067 |
| Phone Number: | 2147946604 |
| Fax Number: | |
| NPI Enumeration Date: | 03/09/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 1115061 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |