Provider Demographics
NPI:1558405233
Name:CORWIN, JAMES W (PT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:W
Last Name:CORWIN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:733 DUNLAWTON AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-4225
Mailing Address - Country:US
Mailing Address - Phone:386-756-0077
Mailing Address - Fax:386-756-6811
Practice Address - Street 1:733 DUNLAWTON AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-4225
Practice Address - Country:US
Practice Address - Phone:386-756-0077
Practice Address - Fax:386-756-6811
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPT4460225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY2745ZMedicare PIN
FLX1320Medicare PIN
FLY2745Medicare PIN