Provider Demographics
NPI:1205980265
Name:MCCORD, JOEL E (PT)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:E
Last Name:MCCORD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 W COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-5521
Mailing Address - Country:US
Mailing Address - Phone:256-718-4041
Mailing Address - Fax:256-718-3665
Practice Address - Street 1:128 W TOMBIGBEE ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-5422
Practice Address - Country:US
Practice Address - Phone:256-718-2075
Practice Address - Fax:256-718-2069
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH2642225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051513355Medicare ID - Type Unspecified
ALP82896Medicare UPIN