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General NPI Number Information
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NPI Number | 1619115441
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Entity Type | Individual
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Provider Name | GIL CORPUZ ANTONIO JR. P.T.
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Gender | Male
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Dates
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Enumeration Date | 02/02/2009
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Last Update Date | 02/02/2009
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Provider Practice Location Address
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Address Line | 481 INDIGO RIDGE DR.
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City | COLUMBIA
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State | SC
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Zip | 29229
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Country | US
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Telephone | 252-655-1246
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Fax |
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Provider Business Mailing Address
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Address Line | 481 INDIGO RIDGE DR
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City | COLUMBIA
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State | SC
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Zip | 29229-7157
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Country | US
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Telephone | 252-655-1246
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Fax |
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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 | 40QA01303700
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License Number State | NJ
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