Provider Demographics
NPI:1851453062
Name:CORBETT, BRIAN (PT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:CORBETT
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 1:824 W LEWIS ST STE 204
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-5561
Mailing Address - Country:US
Mailing Address - Phone:509-544-0265
Mailing Address - Fax:509-544-0304
Practice Address - Street 1:1300 E GRANT ST STE 100
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OR
Practice Address - Zip Code:97355-9539
Practice Address - Country:US
Practice Address - Phone:541-258-8222
Practice Address - Fax:541-258-8221
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4566225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR231020Medicaid
ORR115373Medicare PIN