Individual
MR. DEMETRIO SANTIAGO CORNELIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1818 HOLLAND AVE, BRONX, NY 10462-3625
(347) 657-0162
Mailing address
1818 HOLLAND AVE, BRONX, NY 10462-3625
(347) 657-0162
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
017865
NY
2251G0304X
Geriatric Physical Therapist
Primary
017865
NY
2251P0200X
Pediatric Physical Therapist
017865
NY
2251X0800X
Orthopedic Physical Therapist
017865
NY
Other
Enumeration date
07/26/2010
Last updated
07/26/2010
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