Provider Demographics
NPI:1265475149
Name:CORNELL, AMY L (DPT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:CORNELL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:AMY
Other - Middle Name:L
Other - Last Name:MCBREEN-BABB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2721 SW 3RD PL
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-3109
Mailing Address - Country:US
Mailing Address - Phone:352-204-7651
Mailing Address - Fax:
Practice Address - Street 1:2721 SW 3RD PL
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-3109
Practice Address - Country:US
Practice Address - Phone:352-204-7651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT018683225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY904XOtherBCBS PROVIDER NUMBER
FLE7768AMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER