Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 05003448A | IN |
NPI | 1003081704 |
---|---|
Provider Name | Kristene Marie Corbin |
First Address | Indianapolis, IN 46217-7433 |
Second Address | Indianapolis, IN 46220-2458 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2008 |
Last Update Date | 24/04/2008 |