Provider Demographics
NPI:1992393862
Name:LONGOBARDI CORZO, ANTHOMAS ELZARETH (PTA)
Entity Type:Individual
Prefix:
First Name:ANTHOMAS
Middle Name:ELZARETH
Last Name:LONGOBARDI CORZO
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9550 MEYER FOREST DR APT 1125
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-4352
Mailing Address - Country:US
Mailing Address - Phone:832-306-7971
Mailing Address - Fax:
Practice Address - Street 1:9550 MEYER FOREST DR APT 1125
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77096-4352
Practice Address - Country:US
Practice Address - Phone:832-306-7971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2155157225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant