Provider Demographics
NPI:1720974298
Name:STEFANSKI, CORBIN JOHN (DPT)
Entity type:Individual
Prefix:DR
First Name:CORBIN
Middle Name:JOHN
Last Name:STEFANSKI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6210 MOUNT MARIA RD
Mailing Address - Street 2:
Mailing Address - City:HUBBARD LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49747-9621
Mailing Address - Country:US
Mailing Address - Phone:989-482-6271
Mailing Address - Fax:989-482-6271
Practice Address - Street 1:3899 W FRONT ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-8103
Practice Address - Country:US
Practice Address - Phone:231-944-6541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-13
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501303926225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist