Provider Demographics
NPI:1821324070
Name:KORNELIUS, ROTHEA (PT)
Entity Type:Individual
Prefix:DR
First Name:ROTHEA
Middle Name:
Last Name:KORNELIUS
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 1:507 N LUNENBURG AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH HILL
Mailing Address - State:VA
Mailing Address - Zip Code:23970-1625
Mailing Address - Country:US
Mailing Address - Phone:434-447-3527
Mailing Address - Fax:
Practice Address - Street 1:507 N LUNENBURG AVE
Practice Address - Street 2:
Practice Address - City:SOUTH HILL
Practice Address - State:VA
Practice Address - Zip Code:23970-1625
Practice Address - Country:US
Practice Address - Phone:434-447-3527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-22
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203430225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist