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General NPI Number Information
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NPI Number | 1114247277
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Entity Type | Individual
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Provider Name | MRS. CAROL DALIRE CORPUZ
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Gender | Female
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Dates
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Enumeration Date | 06/10/2010
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Last Update Date | 02/19/2020
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Provider Practice Location Address
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Address Line | 624 AVON PL
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City | NAPOLEON
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State | OH
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Zip | 43545-1721
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Country | US
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Telephone | 410-736-1049
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Fax |
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Provider Business Mailing Address
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Address Line | 790 REMINGTON BLVD
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City | BOLINGBROOK
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State | IL
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Zip | 60440-4909
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Country | US
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Telephone | 866-370-8206
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Fax | 517-435-3670
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 12675
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License Number State | OH
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