Provider Demographics
NPI:1114247277
Name:CORPUZ, CAROL DALIRE
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:DALIRE
Last Name:CORPUZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:CAROL
Other - Middle Name:PAAT
Other - Last Name:DALIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:866-370-8206
Mailing Address - Fax:517-435-3670
Practice Address - Street 1:624 AVON PL
Practice Address - Street 2:
Practice Address - City:NAPOLEON
Practice Address - State:OH
Practice Address - Zip Code:43545-1721
Practice Address - Country:US
Practice Address - Phone:410-736-1049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH12675225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist