Healthcare Provider Details

I. General information

NPI: 1598958712
Provider Name (Legal Business Name): NICOLE M CORRENTI MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE MARIE MALVESTI

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 N ROCKTON AVE
ROCKFORD IL
61103-3619
US

IV. Provider business mailing address

2400 N ROCKTON AVE ATT. CHRIS LABONTE, RMH MED STAFF
ROCKFORD IL
61103-3655
US

V. Phone/Fax

Practice location:
  • Phone: 815-971-2000
  • Fax:
Mailing address:
  • Phone: 815-971-2248
  • Fax: 815-968-9340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070014649
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: