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General NPI Number Information
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NPI Number | 1912120346
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Entity Type | Individual
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Provider Name | VALERIE J CORNWALL PT
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Gender | Female
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 09/19/2018
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Provider Practice Location Address
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Address Line | 3400 WILSON AVE SW
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City | GRANDVILLE
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State | MI
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Zip | 49418-1854
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Country | US
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Telephone | 616-534-5487
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Fax |
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Provider Business Mailing Address
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Address Line | 205 PROSPECT ST
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City | ROCKFORD
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State | MI
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Zip | 49341-1140
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Country | US
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Telephone | 616-490-5903
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501003995
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License Number State | MI
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