Provider Demographics
NPI:1225278633
Name:ADRIAN CORNELIO, P.A.
Entity Type:Organization
Organization Name:ADRIAN CORNELIO, P.A.
Other - Org Name:THERASKILLS, P.A.
Other - Org Type:Other Name
Authorized Official - Title/Position:P.T./PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CORNELIO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:870-933-8006
Mailing Address - Street 1:3908 CHARLESTON DR.
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404
Mailing Address - Country:US
Mailing Address - Phone:870-933-8006
Mailing Address - Fax:870-933-8006
Practice Address - Street 1:1116 N NEW YORK ST EXTENSION
Practice Address - Street 2:
Practice Address - City:BRINKLEY
Practice Address - State:AR
Practice Address - Zip Code:72021
Practice Address - Country:US
Practice Address - Phone:870-734-1155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR148352742Medicaid