Provider Demographics
NPI:1376799320
Name:CORNISH, RONALD BRIAN (CMT)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:BRIAN
Last Name:CORNISH
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20010 KELLY RD
Mailing Address - Street 2:
Mailing Address - City:HARPERWOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48225
Mailing Address - Country:US
Mailing Address - Phone:313-587-3488
Mailing Address - Fax:
Practice Address - Street 1:20010 KELLY RD
Practice Address - Street 2:
Practice Address - City:HARPERWOODS
Practice Address - State:MI
Practice Address - Zip Code:48225
Practice Address - Country:US
Practice Address - Phone:313-587-3488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-11
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist