MEDICARE: JAZMINE CORNELL

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	225200000X	Physical Therapy Assistant	PTA.08156	OH

General Provider Information

NPI Number	:	1689076804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAZMINE CORNELL

Provider Business Mailing Address
First Line	:	140 N CHERRY ST
Second Line	:
City	:	MOUNT GILEAD
State	:	OH
Zip	:	43338-1267
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	140 N CHERRY ST
Second Line	:
City	:	MOUNT GILEAD
State	:	OH
Zip	:	43338-1267
Country	:	US
Telephone Number	:	419-688-2725
Fax Number	:

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

Provider Enumeration Date	:	09/18/2014
Last Update Date	:	09/18/2014

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Directions to “ JAZMINE CORNELL ” Practice Location

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