Healthcare Provider Details

I. General information

NPI: 1053625434
Provider Name (Legal Business Name): JOHN A CORBO PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2010
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1398 LAKE ST S STE 100
FOREST LAKE MN
55025-2720
US

IV. Provider business mailing address

3500 AMERICAN BLVD W STE 300
BLOOMINGTON MN
55431-4442
US

V. Phone/Fax

Practice location:
  • Phone: 651-275-2700
  • Fax: 651-309-0000
Mailing address:
  • Phone: 952-512-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8514
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: