Provider Demographics
NPI:1881108165
Name:CORNALO, ANDREA LORENA (PT)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:LORENA
Last Name:CORNALO
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 1:555 NE 34TH ST APT 2202
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-4058
Mailing Address - Country:US
Mailing Address - Phone:786-877-2799
Mailing Address - Fax:
Practice Address - Street 1:555 NE 34TH ST APT 2202
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-4058
Practice Address - Country:US
Practice Address - Phone:786-877-2799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-26
Last Update Date:2017-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL33226225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist