Provider Demographics
NPI:1073522488
Name:KOREY, CORNELIA (LMT)
Entity Type:Individual
Prefix:MRS
First Name:CORNELIA
Middle Name:
Last Name:KOREY
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 1:303 CORTEZ DR
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-8870
Mailing Address - Country:US
Mailing Address - Phone:904-377-1286
Mailing Address - Fax:
Practice Address - Street 1:2706 OLD MOULTRIE RD
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5447
Practice Address - Country:US
Practice Address - Phone:904-377-1286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA42710225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist