Provider Demographics
NPI:1689941114
Name:CORBACIO, JONATHON (PT)
Entity Type:Individual
Prefix:
First Name:JONATHON
Middle Name:
Last Name:CORBACIO
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 1:160 WHITE RD STE 104
Mailing Address - Street 2:
Mailing Address - City:LITTLE SILVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07739-1167
Mailing Address - Country:US
Mailing Address - Phone:732-383-8295
Mailing Address - Fax:732-383-8370
Practice Address - Street 1:160 WHITE RD STE 104
Practice Address - Street 2:
Practice Address - City:LITTLE SILVER
Practice Address - State:NJ
Practice Address - Zip Code:07739
Practice Address - Country:US
Practice Address - Phone:732-383-8295
Practice Address - Fax:732-383-8370
Is Sole Proprietor?:No
Enumeration Date:2011-11-29
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01417100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ084447Medicare UPIN