Provider Demographics
NPI:1689370579
Name:CORRELL, TONI L (LMT)
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:L
Last Name:CORRELL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6671 EEL RIVER RD N
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:IN
Mailing Address - Zip Code:46926-9170
Mailing Address - Country:US
Mailing Address - Phone:176-547-0174
Mailing Address - Fax:
Practice Address - Street 1:6671 EEL RIVER RD N
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:IN
Practice Address - Zip Code:46926-9170
Practice Address - Country:US
Practice Address - Phone:765-470-1745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INMT22207757225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist