Individual
STEPHEN CORNELISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
1501 TIDEWATER DR, COLUMBIA, MO 65202-6425
(573) 442-9728
Mailing address
1501 TIDEWATER DR, COLUMBIA, MO 65202-6425
(573) 489-2714
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2001015505
MO
Other
Enumeration date
04/24/2007
Last updated
05/22/2008
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