Provider Demographics
NPI:1619376100
Name:CORSINO, JOHNATHAN (DPT)
Entity Type:Individual
Prefix:DR
First Name:JOHNATHAN
Middle Name:
Last Name:CORSINO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 MIDDLE POND PATH
Mailing Address - Street 2:
Mailing Address - City:MARSTONS MILLS
Mailing Address - State:MA
Mailing Address - Zip Code:02648-1432
Mailing Address - Country:US
Mailing Address - Phone:508-292-8276
Mailing Address - Fax:
Practice Address - Street 1:59 MIDDLE POND PATH
Practice Address - Street 2:
Practice Address - City:MARSTONS MILLS
Practice Address - State:MA
Practice Address - Zip Code:02648-1432
Practice Address - Country:US
Practice Address - Phone:508-292-8276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21212225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist