Provider Demographics
NPI:1669422887
Name:BLACKABY, CORRIE SUE (PT, DPT)
Entity type:Individual
Prefix:
First Name:CORRIE
Middle Name:SUE
Last Name:BLACKABY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15953 N GREENWAY HAYDEN LOOP
Mailing Address - Street 2:SUITE #A
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-1765
Mailing Address - Country:US
Mailing Address - Phone:480-998-4848
Mailing Address - Fax:480-998-2207
Practice Address - Street 1:15953 N GREENWAY HAYDEN LOOP
Practice Address - Street 2:SUITE #A
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-1765
Practice Address - Country:US
Practice Address - Phone:480-998-4848
Practice Address - Fax:480-998-2207
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5805225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist