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NPI Code Detail

MEDICARE: DR. CHRISTINE ANGELI JISON CORNEL PT, DPT

MEDICARE: DR. CHRISTINE ANGELI JISON CORNEL PT, DPT
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
1225100000XPhysical Therapist
2225100000XPhysical TherapistPT-2023-2169NM

General Provider Information

NPI Number : 1730873894
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHRISTINE ANGELI JISON CORNEL PT, DPT
Provider Business Mailing Address
First Line : 790 REMINGTON BLVD
Second Line :
City : BOLINGBROOK
State : IL
Zip : 60440-4909
Country : US
Telephone Number : 866-370-8206
Fax Number :
Provider Business Practice Location Address
First Line : 4000 S EASTERN AVE STE 300
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-0826
Country : US
Telephone Number : 702-734-2732
Fax Number : 702-737-1453
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2023
Last Update Date : 10/25/2023

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