Provider Demographics
NPI:1558571398
Name:LUNDELL, CORNELIA CE (PT,MA,PCS)
Entity Type:Individual
Prefix:MS
First Name:CORNELIA
Middle Name:CE
Last Name:LUNDELL
Suffix:
Gender:F
Credentials:PT,MA,PCS
Other - Prefix:MS
Other - First Name:CORNELIA
Other - Middle Name:CE
Other - Last Name:LIEB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT,MA,PCS
Mailing Address - Street 1:5567 CHELSEA AVE
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-7609
Mailing Address - Country:US
Mailing Address - Phone:858-576-2845
Mailing Address - Fax:
Practice Address - Street 1:5567 CHELSEA AVE
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-7609
Practice Address - Country:US
Practice Address - Phone:858-576-2845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 19742251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics