Provider Demographics
NPI:1093212714
Name:DEPRIEST, CORINNE N (LMT)
Entity type:Individual
Prefix:
First Name:CORINNE
Middle Name:N
Last Name:DEPRIEST
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:CORINNE
Other - Middle Name:
Other - Last Name:TERHUNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:1580 E GRAN CIRCULO
Mailing Address - Street 2:
Mailing Address - City:FORT MOHAVE
Mailing Address - State:AZ
Mailing Address - Zip Code:86426-9233
Mailing Address - Country:US
Mailing Address - Phone:928-542-6491
Mailing Address - Fax:
Practice Address - Street 1:1580 E GRAN CIRCULO
Practice Address - Street 2:
Practice Address - City:FORT MOHAVE
Practice Address - State:AZ
Practice Address - Zip Code:86426-9233
Practice Address - Country:US
Practice Address - Phone:928-542-6491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-23150225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist