Provider Demographics
NPI:1386319135
Name:CORBETT, JOLISSA M (DPT)
Entity type:Individual
Prefix:
First Name:JOLISSA
Middle Name:M
Last Name:CORBETT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JOLISSA
Other - Middle Name:M
Other - Last Name:OHRT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2122 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1925
Mailing Address - Country:US
Mailing Address - Phone:630-575-1980
Mailing Address - Fax:
Practice Address - Street 1:701 N ELIDA ST # 1
Practice Address - Street 2:
Practice Address - City:WINNEBAGO
Practice Address - State:IL
Practice Address - Zip Code:61088-8624
Practice Address - Country:US
Practice Address - Phone:815-335-8024
Practice Address - Fax:815-335-8025
Is Sole Proprietor?:No
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-024112225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist