Individual
KATRINA CORGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
11210 95TH ST, COAL VALLEY, IL 61240-9360
(309) 799-3161
Mailing address
440 AVON CT, COLONA, IL 61241-9643
(309) 799-3161
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160.003548
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
160.003548
IL STATE LICENSE TO PRACTICE
IL
Enumeration date
05/15/2008
Last updated
05/15/2008
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