Provider Demographics
NPI:1205196581
Name:CORNISH, VINCENT D (AA/LA; AS/FT; H)
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:D
Last Name:CORNISH
Suffix:
Gender:M
Credentials:AA/LA; AS/FT; H
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 PROSPECTOR RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:NV
Mailing Address - Zip Code:89403-5601
Mailing Address - Country:US
Mailing Address - Phone:719-930-6896
Mailing Address - Fax:
Practice Address - Street 1:317 PROSPECTOR RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:NV
Practice Address - Zip Code:89403-5601
Practice Address - Country:US
Practice Address - Phone:719-930-6896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner