Individual
MRS. DIVINA DACANAY CORNELIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHYSICAL THERAPIST
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
021725
NY
2251G0304X
Geriatric Physical Therapist
021725
NY
2251P0200X
Pediatric Physical Therapist
Primary
021725
NY
Other
Enumeration date
07/26/2010
Last updated
07/26/2010
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