Organization
PREMIER THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM H CORNELIUS MS CCCSLP (PRESIDENT)
(256) 844-2992
Entity
Organization
Contact information
Practice address
213 38TH ST NE, FORT PAYNE, AL 35967-3909
(256) 844-2992
Mailing address
213 38TH ST NE, FORT PAYNE, AL 35967-3909
(256) 844-2992
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
17240
AL
235Z00000X
Speech-Language Pathologist
Primary
1404
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
529920120
—
AL
05
—
890017380
—
AL
Enumeration date
09/21/2006
Last updated
02/03/2015
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