Provider Demographics
NPI:1639456569
Name:KORB, KARL KELLY (PT)
Entity Type:Individual
Prefix:MR
First Name:KARL
Middle Name:KELLY
Last Name:KORB
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 1:1610 GREENUP ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41011-3443
Mailing Address - Country:US
Mailing Address - Phone:513-300-8930
Mailing Address - Fax:859-431-2391
Practice Address - Street 1:1610 GREENUP ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41011-3443
Practice Address - Country:US
Practice Address - Phone:513-300-8930
Practice Address - Fax:859-431-2391
Is Sole Proprietor?:No
Enumeration Date:2011-11-06
Last Update Date:2011-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPT002637225100000X
OHPT007099225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist