Provider Demographics
NPI:1558680652
Name:CORNILLOT, HECTOR FRANSIS (PTA)
Entity Type:Individual
Prefix:MR
First Name:HECTOR
Middle Name:FRANSIS
Last Name:CORNILLOT
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 BETHLEHEM PIKE
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19118-2815
Mailing Address - Country:US
Mailing Address - Phone:610-416-4434
Mailing Address - Fax:
Practice Address - Street 1:184 BETHLEHEM PIKE
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19118-2815
Practice Address - Country:US
Practice Address - Phone:610-416-4434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-28
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE008393225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant