Healthcare Provider Details

I. General information

NPI: 1396651451
Provider Name (Legal Business Name): JUSTIN PATRICK CORIALE PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17332 VON KARMAN AVE STE 120
IRVINE CA
92614-6282
US

IV. Provider business mailing address

7605 S KISSIMMEE ST
TAMPA FL
33616-2805
US

V. Phone/Fax

Practice location:
  • Phone: 949-861-8600
  • Fax: 949-861-8601
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT21638
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: