Provider Demographics
NPI:1073889804
Name:CORBO, SALLY MARIE (MS,PT)
Entity Type:Individual
Prefix:MS
First Name:SALLY
Middle Name:MARIE
Last Name:CORBO
Suffix:
Gender:F
Credentials:MS,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 HILLCREST AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-2734
Mailing Address - Country:US
Mailing Address - Phone:718-356-8575
Mailing Address - Fax:
Practice Address - Street 1:15 FAIRFIELD ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10308-1823
Practice Address - Country:US
Practice Address - Phone:718-984-9800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024259225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist