Provider Demographics
NPI:1568583094
Name:CORRAL, MYRAH NINA (PT)
Entity Type:Individual
Prefix:MRS
First Name:MYRAH
Middle Name:NINA
Last Name:CORRAL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:MYRAH
Other - Middle Name:NINA
Other - Last Name:ABRAGAN-CORRAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:4932 N HIGHLAND CT
Mailing Address - Street 2:
Mailing Address - City:BEL AIRE
Mailing Address - State:KS
Mailing Address - Zip Code:67220-1665
Mailing Address - Country:US
Mailing Address - Phone:316-744-7012
Mailing Address - Fax:
Practice Address - Street 1:622 N EDGEMOOR ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-3602
Practice Address - Country:US
Practice Address - Phone:316-686-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-02306225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist