Provider Demographics
NPI:1033591797
Name:LAFRANCE, CORBETT (AT, ATC)
Entity Type:Individual
Prefix:
First Name:CORBETT
Middle Name:
Last Name:LAFRANCE
Suffix:
Gender:M
Credentials:AT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3511 FAWN COVE LN APT 1
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-4778
Mailing Address - Country:US
Mailing Address - Phone:989-737-0854
Mailing Address - Fax:
Practice Address - Street 1:3511 FAWN COVE LN APT 1
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-4778
Practice Address - Country:US
Practice Address - Phone:989-737-0854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-18
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI26010013872255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer