MEDICARE: MRS. JAMIE LYNN KORNEGAY

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	5754	SC

General Provider Information

NPI Number	:	1881775286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JAMIE LYNN KORNEGAY

Provider Business Mailing Address
First Line	:	5111 N RHETT AVE
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29405-4219
Country	:	US
Telephone Number	:	843-576-4121
Fax Number	:	843-793-3575

Provider Business Practice Location Address
First Line	:	2267 ASHLEY RIVER RD
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29414-4736
Country	:	US
Telephone Number	:	843-576-4121
Fax Number	:	843-793-3575

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

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	12/16/2025

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