Provider Demographics
NPI:1376632273
Name:CORRIVEAU, KAREN MARIA (PT)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:MARIA
Last Name:CORRIVEAU
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:KAREN
Other - Middle Name:MARIA
Other - Last Name:KROHOMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3428 BUENA VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-1505
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:801 S RAYMOND AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3223
Practice Address - Country:US
Practice Address - Phone:626-356-0599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT21776225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT 21776BMedicare ID - Type Unspecified