Provider Demographics
NPI:1447690672
Name:GADDIS, CORINNE ELIZABETH (ATC, ATC/L)
Entity type:Individual
Prefix:
First Name:CORINNE
Middle Name:ELIZABETH
Last Name:GADDIS
Suffix:
Gender:F
Credentials:ATC, ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 NW NORTH ST
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-3632
Mailing Address - Country:US
Mailing Address - Phone:360-672-5027
Mailing Address - Fax:
Practice Address - Street 1:825 SE BISHOP BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-5517
Practice Address - Country:US
Practice Address - Phone:509-332-2828
Practice Address - Fax:509-334-7474
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAA1602512762255A2300X
IDAT-4592255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer