Healthcare Provider Details

I. General information

NPI: 1154600468
Provider Name (Legal Business Name): KARLY CORNEILLE RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2011
Last Update Date: 08/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 WEYBRIDGE CIR APT C
ROYAL PALM BEACH FL
33411-1517
US

IV. Provider business mailing address

106 WEYBRIDGE CIRCLE APT C
ROYAL PALM BEACH FL
33411-1517
US

V. Phone/Fax

Practice location:
  • Phone: 561-633-7418
  • Fax:
Mailing address:
  • Phone: 561-633-7418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279G1100X
TaxonomyGeneral Care Registered Respiratory Therapist
License NumberRT6924
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: