Provider Demographics
NPI:1881974483
Name:J. CORNACK THERAPY GROUP LLC
Entity type:Organization
Organization Name:J. CORNACK THERAPY GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORNACK
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:813-956-2027
Mailing Address - Street 1:604 COURTHOUSE CIR
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-8028
Mailing Address - Country:US
Mailing Address - Phone:813-956-2027
Mailing Address - Fax:
Practice Address - Street 1:604 COURTHOUSE CIR
Practice Address - Street 2:
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-8028
Practice Address - Country:US
Practice Address - Phone:813-956-2027
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency