Individual
KIMBERLY N. GREGG-CORNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
280 PATTONSVILLE RD, JACKSON, OH 45640-9452
(740) 395-8852
(740) 395-8855
Mailing address
90 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(740) 395-8805
(740) 395-8855
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
013218
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000433620
OH MEDICAID UNISON
OH
01
—
0050776
OHIO MEDICAID MOLINA
OH
05
—
0050776
—
OH
01
—
310917085261
OHIO MEDICAID CARESOURCE
OH
05
—
3810021365
—
WV
Enumeration date
07/24/2011
Last updated
10/21/2011
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