Healthcare Provider Details

I. General information

NPI: 1700716552
Provider Name (Legal Business Name): DIANA KORNETTI PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95127 SNAPDRAGON DR
FERNANDINA BEACH FL
32034-0030
US

IV. Provider business mailing address

95127 SNAPDRAGON DR
FERNANDINA BEACH FL
32034-0030
US

V. Phone/Fax

Practice location:
  • Phone: 352-362-6733
  • Fax:
Mailing address:
  • Phone: 352-362-6733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT4554
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: