Provider Demographics
NPI:1174048300
Name:VALIQUETTE, CORRINE NICOLE (DPT)
Entity type:Individual
Prefix:MRS
First Name:CORRINE
Middle Name:NICOLE
Last Name:VALIQUETTE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:CORRINE
Other - Middle Name:NICOLE
Other - Last Name:GUSTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:6821 GILES RD APT 302
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68133-2189
Mailing Address - Country:US
Mailing Address - Phone:815-245-6900
Mailing Address - Fax:
Practice Address - Street 1:1702 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-3652
Practice Address - Country:US
Practice Address - Phone:402-682-4214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-09
Last Update Date:2017-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3734225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist