Provider Demographics
NPI:1962926196
Name:CORBITT, ANNEMIEKE DIONNE (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:ANNEMIEKE
Middle Name:DIONNE
Last Name:CORBITT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:MIEKE
Other - Middle Name:DIONNE
Other - Last Name:CORBITT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:2100 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-2758
Mailing Address - Country:US
Mailing Address - Phone:479-968-2525
Mailing Address - Fax:479-968-2538
Practice Address - Street 1:100 WALMART DR
Practice Address - Street 2:
Practice Address - City:MORRILTON
Practice Address - State:AR
Practice Address - Zip Code:72110-4522
Practice Address - Country:US
Practice Address - Phone:501-477-2202
Practice Address - Fax:541-421-0543
Is Sole Proprietor?:No
Enumeration Date:2017-07-30
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT3074225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR222221721Medicaid