MEDICARE: KYLE G CORBIN PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT21893	FL

General Provider Information

NPI Number	:	1437154804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLE G CORBIN PT

Provider Business Mailing Address
First Line	:	14546 OLD SAINT AUGUSTINE RD
Second Line	:	SUITE 209
City	:	JACKSONVILLE
State	:	FL
Zip	:	32258-5468
Country	:	US
Telephone Number	:	904-821-6575
Fax Number	:	904-821-6678

Provider Business Practice Location Address
First Line	:	14546 OLD SAINT AUGUSTINE RD
Second Line	:	SUITE 209
City	:	JACKSONVILLE
State	:	FL
Zip	:	32258-5468
Country	:	US
Telephone Number	:	904-821-6575
Fax Number	:	904-821-6678

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	07/30/2007

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Directions to “ KYLE G CORBIN PT” Practice Location

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