Provider Demographics
NPI:1013328863
Name:TANGUAY, CORINA
Entity Type:Individual
Prefix:
First Name:CORINA
Middle Name:
Last Name:TANGUAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 CLARK SHORE RD
Mailing Address - Street 2:
Mailing Address - City:HARPSWELL
Mailing Address - State:ME
Mailing Address - Zip Code:04079-3128
Mailing Address - Country:US
Mailing Address - Phone:207-751-1986
Mailing Address - Fax:
Practice Address - Street 1:58 CLARK SHORE RD
Practice Address - Street 2:
Practice Address - City:HARPSWELL
Practice Address - State:ME
Practice Address - Zip Code:04079-3128
Practice Address - Country:US
Practice Address - Phone:207-751-1986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT2821225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist