Individual
JEAN DIANE KORNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
2675 COURT DRIVE, GASTONIA, NC 28054
(704) 824-7800
(704) 824-2853
Mailing address
2675 COURT DRIVE, GASTONIA, NC 28054
(704) 824-7800
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
1148
SC
225100000X
Physical Therapist
Primary
3757
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
720132B
—
NC
Enumeration date
10/31/2006
Last updated
07/08/2007
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