Provider Demographics
NPI:1619376068
Name:CORBIN, SAMUEL (PT)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:CORBIN
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 1:6565 ARLINGTON BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-3000
Mailing Address - Country:US
Mailing Address - Phone:703-942-8824
Mailing Address - Fax:703-942-8834
Practice Address - Street 1:6565 ARLINGTON BLVD STE 220
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-3000
Practice Address - Country:US
Practice Address - Phone:703-942-8824
Practice Address - Fax:703-942-8834
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305207687261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy