Provider Demographics
NPI:1114452315
Name:CORBITT, ALEXANDRA L (MSAT, ATC)
Entity Type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:L
Last Name:CORBITT
Suffix:
Gender:F
Credentials:MSAT, ATC
Other - Prefix:MS
Other - First Name:ALEXANDRA
Other - Middle Name:L
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSAT, ATC
Mailing Address - Street 1:310 VIRGINIA ST
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:WV
Mailing Address - Zip Code:26184-8132
Mailing Address - Country:US
Mailing Address - Phone:918-261-4714
Mailing Address - Fax:
Practice Address - Street 1:223 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:WV
Practice Address - Zip Code:26426-1227
Practice Address - Country:US
Practice Address - Phone:304-326-1385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-25
Last Update Date:2019-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK8492255A2300X
WVAT0012112255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVAT001211OtherWV BOARD OF PHYSICAL THERAPY