Provider Demographics
NPI:1760442479
Name:CORBETT, LENORA (PT)
Entity type:Individual
Prefix:MS
First Name:LENORA
Middle Name:
Last Name:CORBETT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4145 MOURNING DOVE CT
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32934-8523
Mailing Address - Country:US
Mailing Address - Phone:321-752-4237
Mailing Address - Fax:
Practice Address - Street 1:2401 W EAU GALLIE BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-2765
Practice Address - Country:US
Practice Address - Phone:321-259-6599
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 2479225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist