Provider Demographics
NPI:1215626833
Name:CORBRIDGE PODIATRY PLLC
Entity type:Organization
Organization Name:CORBRIDGE PODIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TREG
Authorized Official - Middle Name:
Authorized Official - Last Name:CORBRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:801-515-7997
Mailing Address - Street 1:950 N ABBEY DR
Mailing Address - Street 2:
Mailing Address - City:NORTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84054-5500
Mailing Address - Country:US
Mailing Address - Phone:801-515-7997
Mailing Address - Fax:
Practice Address - Street 1:903 S MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:BRIGHAM CITY
Practice Address - State:UT
Practice Address - Zip Code:84302-3112
Practice Address - Country:US
Practice Address - Phone:801-515-7997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty