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General NPI Number Information
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NPI Number | 1003622705
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Entity Type | Individual
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Provider Name | AMANDA CORNELIUS PTA
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Gender | Female
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Dates
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Enumeration Date | 12/06/2024
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Last Update Date | 12/06/2024
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Provider Practice Location Address
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Address Line | 4320 BRIDGETOWN RD
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City | CINCINNATI
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State | OH
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Zip | 45211-4428
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Country | US
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Telephone | 740-577-8813
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Fax |
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Provider Business Mailing Address
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Address Line | 5006 DONLAR AVE
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City | CINCINNATI
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State | OH
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Zip | 45238-5329
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Country | US
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Telephone | 740-577-8813
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 007677
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License Number State | OH
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