Provider Demographics
NPI:1831671189
Name:CORNELIUS, KENDRA B (DPT)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:B
Last Name:CORNELIUS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:B
Other - Last Name:BREUNLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 7840
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92607-7840
Mailing Address - Country:US
Mailing Address - Phone:949-443-5442
Mailing Address - Fax:949-443-5463
Practice Address - Street 1:31271 NIGUEL RD STE J
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-4135
Practice Address - Country:US
Practice Address - Phone:949-443-5442
Practice Address - Fax:949-443-5463
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA295145225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist