MEDICARE: MS. CANDACE ANN CORNETT PT

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	225100000X	Physical Therapist	23810	CA

General Provider Information

NPI Number	:	1730168253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CANDACE ANN CORNETT PT

Provider Business Mailing Address
First Line	:	1609 FIRESIDE WAY
Second Line	:
City	:	LEMOORE
State	:	CA
Zip	:	93245-1715
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	937 FRANKLIN AVE
Second Line	:
City	:	LEMOORE
State	:	CA
Zip	:	93246-0001
Country	:	US
Telephone Number	:	559-998-4262
Fax Number	:	559-998-3411

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

Provider Enumeration Date	:	01/12/2006
Last Update Date	:	08/25/2008

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