Provider Demographics
NPI:1033385208
Name:CORNISH, JULIE ANNE (LMT)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:ANNE
Last Name:CORNISH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11912 ELM ST
Mailing Address - Street 2:STE. 101
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-4443
Mailing Address - Country:US
Mailing Address - Phone:402-870-0919
Mailing Address - Fax:
Practice Address - Street 1:11912 ELM ST
Practice Address - Street 2:STE. 101
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-4443
Practice Address - Country:US
Practice Address - Phone:402-870-0919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2084225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist