Provider Demographics
NPI:1295167344
Name:STRUBLE, CORRIE LYNN (PHD, ATC, LAT)
Entity type:Individual
Prefix:DR
First Name:CORRIE
Middle Name:LYNN
Last Name:STRUBLE
Suffix:
Gender:F
Credentials:PHD, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 SKIPWYTH CIR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-2415
Mailing Address - Country:US
Mailing Address - Phone:912-531-1581
Mailing Address - Fax:
Practice Address - Street 1:111 SKIPWYTH CIR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-2415
Practice Address - Country:US
Practice Address - Phone:912-531-1581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20522255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer