=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639002033
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHERWIN RACUYAL CORRALES
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2026
-----------------------------------------------------
Last Update Date | 06/04/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 560 DICKENS DR
-----------------------------------------------------
City | HUMMELSTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17036-7028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-233-0693
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 560 DICKENS DR
-----------------------------------------------------
City | HUMMELSTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17036-7028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-233-0693
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 034200
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------