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General NPI Number Information
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NPI Number | 1811504723
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Entity Type | Individual
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Provider Name | MORGAN TYLER KORNBLUM PT, DPT, ATC
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Gender | Female
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Dates
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Enumeration Date | 09/24/2020
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Last Update Date | 03/09/2021
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Provider Practice Location Address
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Address Line | 2716 ERIE AVE STE B3
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City | CINCINNATI
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State | OH
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Zip | 45208-2135
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Country | US
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Telephone | 513-208-2257
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Fax |
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Provider Business Mailing Address
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Address Line | 512 WARD AVE
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City | BELLEVUE
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State | KY
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Zip | 41073-1506
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Country | US
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Telephone | 859-663-6868
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT018916
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License Number State | KY
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