MEDICARE: MRS. TORIA DAWN CORNETT ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	104-0000138	VT

General Provider Information

NPI Number	:	1487780102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TORIA DAWN CORNETT ATC

Provider Business Mailing Address
First Line	:	411 BLOCKHOUSE POINT RD
Second Line	:
City	:	NORTH HERO
State	:	VT
Zip	:	05474
Country	:	US
Telephone Number	:	802-233-3925
Fax Number	:

Provider Business Practice Location Address
First Line	:	411 BLOCKHOUSE POINT RD
Second Line	:
City	:	NORTH HERO
State	:	VT
Zip	:	05474
Country	:	US
Telephone Number	:	802-233-3925
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	07/08/2007

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