Provider Demographics
NPI:1720287816
Name:TOUSSAINT, CORBETT ELIZABETH (DPM)
Entity Type:Individual
Prefix:MRS
First Name:CORBETT
Middle Name:ELIZABETH
Last Name:TOUSSAINT
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:MS
Other - First Name:CORBETT
Other - Middle Name:ELIZABETH
Other - Last Name:NEAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:600 N WHEELER AVE
Mailing Address - Street 2:
Mailing Address - City:PROSPERITY
Mailing Address - State:SC
Mailing Address - Zip Code:29127-9332
Mailing Address - Country:US
Mailing Address - Phone:803-767-1023
Mailing Address - Fax:
Practice Address - Street 1:600 N WHEELER AVE
Practice Address - Street 2:
Practice Address - City:PROSPERITY
Practice Address - State:SC
Practice Address - Zip Code:29127-9332
Practice Address - Country:US
Practice Address - Phone:803-767-1023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016.005251213E00000X
SC0619213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016.005251OtherSTATE LICENSE NUMBER
SC0619OtherSOUTH CAROLINA LICENSE