Provider Demographics
NPI:1386668374
Name:CORNICK, DEBRA (PT)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:CORNICK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4225 GOLDEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-4215
Mailing Address - Country:US
Mailing Address - Phone:763-302-4102
Mailing Address - Fax:763-287-2309
Practice Address - Street 1:4225 GOLDEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-4215
Practice Address - Country:US
Practice Address - Phone:763-302-4102
Practice Address - Fax:763-287-2309
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2570225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP44361OtherHEALTHPARTNERS
MN962871010735OtherPREFERRED ONE
MN44B88COOtherBCBS OF MN
MN6401553OtherMEDICA
MN859687OtherAMERICA'S PPO