Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 05004939A | IN |
NPI | 1174720189 |
---|---|
Provider Name | Mrs. Cheryl J Cornelius |
First Address | Washington, IN 47501-7215 |
Second Address | Washington, IN 47501-4373 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2007 |
Last Update Date | 08/07/2007 |