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General NPI Number Information
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NPI Number | 1861669046
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Entity Type | Individual
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Provider Name | KATRINA CORGAN PTA
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Gender | Female
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Dates
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Enumeration Date | 05/15/2008
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Last Update Date | 05/15/2008
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Provider Practice Location Address
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Address Line | 11210 95TH ST
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City | COAL VALLEY
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State | IL
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Zip | 61240-9360
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Country | US
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Telephone | 309-799-3161
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Fax |
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Provider Business Mailing Address
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Address Line | 440 AVON CT
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City | COLONA
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State | IL
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Zip | 61241-9643
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Country | US
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Telephone | 309-799-3161
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 160.003548
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License Number State | IL
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