Provider Demographics
NPI:1982762530
Name:SAMPSON, CORINNE A (PT)
Entity Type:Individual
Prefix:MRS
First Name:CORINNE
Middle Name:A
Last Name:SAMPSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:CORINNE
Other - Middle Name:A
Other - Last Name:QUEEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:259 OAK PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-7726
Mailing Address - Country:US
Mailing Address - Phone:601-941-5566
Mailing Address - Fax:601-607-6988
Practice Address - Street 1:259 OAK PARK DRIVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-7726
Practice Address - Country:US
Practice Address - Phone:601-941-5566
Practice Address - Fax:601-607-6988
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist