Provider Demographics
NPI:1316979800
Name:TOKHEIM CORBETT PHYSICAL THERAPY
Entity type:Organization
Organization Name:TOKHEIM CORBETT PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:HAL
Authorized Official - Middle Name:
Authorized Official - Last Name:CORBETT
Authorized Official - Suffix:II
Authorized Official - Credentials:PT
Authorized Official - Phone:209-824-9888
Mailing Address - Street 1:1191 E YOSEMITE AVE
Mailing Address - Street 2:STE. A
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336-5011
Mailing Address - Country:US
Mailing Address - Phone:209-824-9888
Mailing Address - Fax:209-824-9469
Practice Address - Street 1:1191 E YOSEMITE AVE
Practice Address - Street 2:STE A
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-5011
Practice Address - Country:US
Practice Address - Phone:209-579-5628
Practice Address - Fax:209-579-5637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ07820ZOtherBLUE SHIELD
CADC0745OtherRAILROAD MEDICARE
CAZZZ07820ZOtherBLUE SHIELD