Provider Demographics
NPI:1235435710
Name:CORBITT, BROOK BRADFORD (PT)
Entity Type:Individual
Prefix:
First Name:BROOK
Middle Name:BRADFORD
Last Name:CORBITT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8925 W RUSSELL RD
Mailing Address - Street 2:# 140
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-1219
Mailing Address - Country:US
Mailing Address - Phone:702-914-6787
Mailing Address - Fax:702-914-6885
Practice Address - Street 1:3831 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1859
Practice Address - Country:US
Practice Address - Phone:702-876-1733
Practice Address - Fax:702-878-2018
Is Sole Proprietor?:No
Enumeration Date:2011-02-01
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2522225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist