Provider Demographics
NPI:1124489802
Name:CORBETT, DUSTIN (PT)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:
Last Name:CORBETT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2141 N ASPENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-6941
Mailing Address - Country:US
Mailing Address - Phone:817-773-2557
Mailing Address - Fax:
Practice Address - Street 1:6151 COUNTY ROAD 124 STE 200
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-4837
Practice Address - Country:US
Practice Address - Phone:972-645-1833
Practice Address - Fax:972-645-1834
Is Sole Proprietor?:No
Enumeration Date:2016-03-09
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1271057225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1271057OtherPT LICENSE