Provider Demographics
NPI:1205317153
Name:CORBIN, KATELYN (DPT)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:CORBIN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3332 CRANMORE CHASE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-4790
Mailing Address - Country:US
Mailing Address - Phone:404-406-2647
Mailing Address - Fax:
Practice Address - Street 1:980 WOODSTOCK PKWY STE 200
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-4871
Practice Address - Country:US
Practice Address - Phone:678-445-9799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT013645225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist