Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 31335 | FL |
N | 2251N0400X | Physical Therapist - Neurology | 40QA01439300 | NJ |
NPI | 1043741242 |
---|---|
Provider Name | Samantha Corkwell |
First Address | Orlando, FL 32814-6363 |
Second Address | Orlando, FL 32804-1331 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2017 |
Last Update Date | 21/03/2017 |