Provider Demographics
NPI:1396375986
Name:MURPHY, CORINNE LEE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:CORINNE
Middle Name:LEE
Last Name:MURPHY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 KIERRA PL
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-8556
Mailing Address - Country:US
Mailing Address - Phone:417-332-7918
Mailing Address - Fax:
Practice Address - Street 1:111 KIERRA PL
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-8556
Practice Address - Country:US
Practice Address - Phone:417-332-7918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4022225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant