Healthcare Provider Details

I. General information

NPI: 1043741242
Provider Name (Legal Business Name): SAMANTHA CORKWELL PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2017
Last Update Date: 03/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5165 ADANSON ST
ORLANDO FL
32804-1331
US

IV. Provider business mailing address

1875 LAKEMONT AVE APT 303
ORLANDO FL
32814-6363
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-7600
  • Fax:
Mailing address:
  • Phone: 732-754-9742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number31335
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number40QA01439300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: