Individual
JASON ROBERT CORNELISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
200 PLEASANT VIEW DR, GEORGETOWN, KY 40324-8303
(904) 806-8102
Mailing address
200 PLEASANT VIEW DR, GEORGETOWN, KY 40324-8303
(904) 806-8102
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
006835
KY
Other
Enumeration date
09/29/2021
Last updated
09/29/2021
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