Provider Demographics
NPI:1043408214
Name:CORNELIO, ADRIAN DELFINO (PT)
Entity Type:Individual
Prefix:
First Name:ADRIAN
Middle Name:DELFINO
Last Name:CORNELIO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25476 E ARBOR DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-6173
Mailing Address - Country:US
Mailing Address - Phone:720-505-8053
Mailing Address - Fax:720-505-8053
Practice Address - Street 1:25476 E ARBOR DR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-6173
Practice Address - Country:US
Practice Address - Phone:720-505-8053
Practice Address - Fax:720-505-8053
Is Sole Proprietor?:No
Enumeration Date:2007-10-11
Last Update Date:2015-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT2170225100000X
COPTL.0011151225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR135580721Medicaid