Individual
JEREMY CORNWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
8786 STATE ROUTE 525, CLINTON, WA 98236
(360) 341-1731
(360) 341-1053
Mailing address
PO BOX 940, CLINTON, WA 98236-0940
(360) 341-1731
(360) 341-1053
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT60041805
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0266242
DEPT OF L&I
WA
01
—
0266257
DEPT OF L&I
WA
01
—
0266279
DEPT OF L&I
WA
01
—
0597CO
REGENCE
WA
01
—
0598CO
REGENCE
WA
01
—
0599CO
REGENCE
WA
01
—
0603CO
REGENCE
WA
01
—
0605CO
REGENCE
WA
01
—
0645CO
REGENCE
WA
01
—
0695CO
REGENCE
WA
01
—
P00893790
RAILROAD MEDICARE
WA
Enumeration date
07/27/2010
Last updated
07/14/2023
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