Provider Demographics
NPI:1952926743
Name:CORBETT, REVAY O (ATC, PHD)
Entity type:Individual
Prefix:PROF
First Name:REVAY
Middle Name:O
Last Name:CORBETT
Suffix:
Gender:F
Credentials:ATC, PHD
Other - Prefix:DR
Other - First Name:REVAY
Other - Middle Name:O
Other - Last Name:CORBETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ATC, PHD
Mailing Address - Street 1:185 NOBLE ST
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-6512
Mailing Address - Country:US
Mailing Address - Phone:929-352-3824
Mailing Address - Fax:
Practice Address - Street 1:185 NOBLE ST
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-6512
Practice Address - Country:US
Practice Address - Phone:929-352-3824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-08
Last Update Date:2020-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0024182081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine