Healthcare Provider Details

I. General information

NPI: 1457402158
Provider Name (Legal Business Name): ROBERT HOBART CORBY PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 11/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1516 W MEQUON RD STE 201
MEQUON WI
53092-3264
US

IV. Provider business mailing address

1516 W MEQUON RD STE 201
MEQUON WI
53092-3264
US

V. Phone/Fax

Practice location:
  • Phone: 262-241-8402
  • Fax: 262-241-8403
Mailing address:
  • Phone: 262-241-8402
  • Fax: 262-241-8403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2328-024
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: