Provider Demographics
NPI:1508219981
Name:CORRALES, GLEYSY
Entity Type:Individual
Prefix:
First Name:GLEYSY
Middle Name:
Last Name:CORRALES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7640 NW 5TH ST APT 2F
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-7912
Mailing Address - Country:US
Mailing Address - Phone:954-913-2983
Mailing Address - Fax:
Practice Address - Street 1:7640 NW 5TH ST APT 2F
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-7912
Practice Address - Country:US
Practice Address - Phone:954-913-2983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-20
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT23144225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist