Provider Demographics
NPI:1104687326
Name:MEDINA, CORINA
Entity type:Individual
Prefix:
First Name:CORINA
Middle Name:
Last Name:MEDINA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32715 FM 1575
Mailing Address - Street 2:
Mailing Address - City:LOS FRESNOS
Mailing Address - State:TX
Mailing Address - Zip Code:78566-5068
Mailing Address - Country:US
Mailing Address - Phone:956-404-3494
Mailing Address - Fax:
Practice Address - Street 1:1200 OVERLOOK DR
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-6605
Practice Address - Country:US
Practice Address - Phone:503-636-4589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-16
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1406420225100000X
NMPT-2025-0054225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist