MEDICARE: TREVOR C CORNIA 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	2567	NV

General Provider Information

NPI Number	:	1801183322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TREVOR C CORNIA PT

Provider Business Mailing Address
First Line	:	3831 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1859
Country	:	US
Telephone Number	:	702-876-1733
Fax Number	:	702-878-2018

Provider Business Practice Location Address
First Line	:	3870 W ANN RD
Second Line	:	STE 110
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-4411
Country	:	US
Telephone Number	:	702-396-7100
Fax Number	:	702-396-9100

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

Provider Enumeration Date	:	07/05/2011
Last Update Date	:	07/05/2011

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