Provider Demographics
NPI:1215002977
Name:CORSO, GARY (MS, PT)
Entity Type:Individual
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First Name:GARY
Middle Name:
Last Name:CORSO
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Gender:M
Credentials:MS, PT
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Mailing Address - Street 1:380 CIVIC DR STE 100
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-1946
Mailing Address - Country:US
Mailing Address - Phone:925-284-6150
Mailing Address - Fax:855-814-4495
Practice Address - Street 1:380 CIVIC DR STE 100
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-1946
Practice Address - Country:US
Practice Address - Phone:925-284-6150
Practice Address - Fax:855-814-5469
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPT42677225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT42677OtherPT BOARD
NYA400020762Medicare PIN
NYQ71563Medicare PIN
NYQ14402Medicare PIN