Healthcare Provider Details

I. General information

NPI: 1306461215
Provider Name (Legal Business Name): SHERRI KORNFELD PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2020
Last Update Date: 06/16/2020
Certification Date: 06/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 N PARKWOOD RD
DECATUR GA
30030-5024
US

IV. Provider business mailing address

702 N PARKWOOD RD
DECATUR GA
30030-5024
US

V. Phone/Fax

Practice location:
  • Phone: 678-907-4266
  • Fax: 855-232-8604
Mailing address:
  • Phone: 678-907-4266
  • Fax: 855-232-8604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4557
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: