Provider Demographics
NPI:1164694576
Name:CORDOVA, KAREN JOY ABANDO
Entity Type:Individual
Prefix:MRS
First Name:KAREN JOY
Middle Name:ABANDO
Last Name:CORDOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 W 5TH ST STE D&E
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-2501
Mailing Address - Country:US
Mailing Address - Phone:417-782-2917
Mailing Address - Fax:417-782-7038
Practice Address - Street 1:18540 STATE HIGHWAY 16
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:MO
Practice Address - Zip Code:63452-2111
Practice Address - Country:US
Practice Address - Phone:573-215-2216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006002905225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist