Provider Demographics
NPI:1699781104
Name:CORBEIL, JENNIFER (PT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:CORBEIL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 BOLT HILL RD
Mailing Address - Street 2:
Mailing Address - City:ELIOT
Mailing Address - State:ME
Mailing Address - Zip Code:03903-1942
Mailing Address - Country:US
Mailing Address - Phone:207-439-5104
Mailing Address - Fax:207-571-8134
Practice Address - Street 1:205 BOLT HILL RD
Practice Address - Street 2:
Practice Address - City:ELIOT
Practice Address - State:ME
Practice Address - Zip Code:03903-1942
Practice Address - Country:US
Practice Address - Phone:207-439-5104
Practice Address - Fax:207-571-8134
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT18742251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics