Provider Demographics
NPI:1821224262
Name:CORWIN, SANDI RENAE (MPT)
Entity Type:Individual
Prefix:
First Name:SANDI
Middle Name:RENAE
Last Name:CORWIN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 TREGINA LN
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-5133
Mailing Address - Country:US
Mailing Address - Phone:605-310-8354
Mailing Address - Fax:
Practice Address - Street 1:113 TREGINA LN
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-5133
Practice Address - Country:US
Practice Address - Phone:605-310-8354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-29
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.0168012251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic