Provider Demographics
NPI:1902997067
Name:CORNELL, DEE (PT ATC)
Entity Type:Individual
Prefix:
First Name:DEE
Middle Name:
Last Name:CORNELL
Suffix:
Gender:F
Credentials:PT ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:POB 1018
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234
Mailing Address - Country:US
Mailing Address - Phone:940-390-7346
Mailing Address - Fax:
Practice Address - Street 1:2800 S FM 51
Practice Address - Street 2:ST B
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234
Practice Address - Country:US
Practice Address - Phone:940-627-7532
Practice Address - Fax:940-627-7547
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1125474225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0217143-01Medicaid
TX456779Medicare Oscar/Certification