Provider Demographics
NPI:1063459295
Name:CORNISH THERAPEUTIC CARE INC
Entity Type:Organization
Organization Name:CORNISH THERAPEUTIC CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:CORNISH
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:727-251-8903
Mailing Address - Street 1:16128 4TH ST E
Mailing Address - Street 2:
Mailing Address - City:REDINGTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33708-1614
Mailing Address - Country:US
Mailing Address - Phone:727-251-8903
Mailing Address - Fax:727-393-5986
Practice Address - Street 1:11590 SEMINOLE BLVD
Practice Address - Street 2:SUITE C-4
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33778-3204
Practice Address - Country:US
Practice Address - Phone:727-251-8903
Practice Address - Fax:727-393-5986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT19198225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL887320896Medicaid
FL889996700Medicaid
FL889996700Medicaid