Provider Demographics
NPI:1700424330
Name:SCHREYER, CORRIN NICOLE (DPT)
Entity Type:Individual
Prefix:
First Name:CORRIN
Middle Name:NICOLE
Last Name:SCHREYER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CORRIN
Other - Middle Name:NICOLE
Other - Last Name:RUSSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:601 E LOCUST ST STE 102
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1941
Mailing Address - Country:US
Mailing Address - Phone:515-421-4018
Mailing Address - Fax:
Practice Address - Street 1:601 E LOCUST ST STE 102
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1941
Practice Address - Country:US
Practice Address - Phone:515-421-4018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-13
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA096839225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist