MEDICARE: BETSY CORNELL LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172M00000X	Mechanotherapist	7260	OH

General Provider Information

NPI Number	:	1104370717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETSY CORNELL LMT

Provider Business Mailing Address
First Line	:	4662 LARWELL DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43220-3621
Country	:	US
Telephone Number	:	614-442-6754
Fax Number	:	614-442-6737

Provider Business Practice Location Address
First Line	:	4662 LARWELL DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43220-3621
Country	:	US
Telephone Number	:	614-442-6754
Fax Number	:	614-442-6737

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2016
Last Update Date	:	08/11/2016

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