Provider Demographics
NPI:1033823869
Name:ROBERTS, CORINNE
Entity type:Individual
Prefix:
First Name:CORINNE
Middle Name:
Last Name:ROBERTS
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 1:6123 E 300 S
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-9741
Mailing Address - Country:US
Mailing Address - Phone:317-498-6768
Mailing Address - Fax:
Practice Address - Street 1:1683 COMMUNITY WAY
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-9397
Practice Address - Country:US
Practice Address - Phone:463-290-8001
Practice Address - Fax:317-708-6496
Is Sole Proprietor?:No
Enumeration Date:2023-01-06
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05005089A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist