Provider Demographics
NPI:1922611128
Name:CORNELIUS, TROY HUNTER
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:HUNTER
Last Name:CORNELIUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 GEORGIA MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:GUNTERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35976-7240
Mailing Address - Country:US
Mailing Address - Phone:205-237-4218
Mailing Address - Fax:
Practice Address - Street 1:501 BLOUNT AVE # A
Practice Address - Street 2:
Practice Address - City:GUNTERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35976-1501
Practice Address - Country:US
Practice Address - Phone:256-486-9478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTA7819225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant