Healthcare Provider Details

I. General information

NPI: 1548411226
Provider Name (Legal Business Name): KRISTEN L CORSI PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2008
Last Update Date: 04/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1706 E SEMORAN BLVD #107
APOPKA FL
32703-5651
US

IV. Provider business mailing address

9100 SUMMIT CENTRE WAY APT 205
ORLANDO FL
32810-5971
US

V. Phone/Fax

Practice location:
  • Phone: 407-880-7772
  • Fax:
Mailing address:
  • Phone: 614-946-2368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPT012250
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPT24533
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: