Individual
MS. JAYLA BETHANY CORNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
17709 OLD JEFFERSON HWY STE A, PRAIRIEVILLE, LA 70769-3977
(225) 677-8400
(225) 977-8484
Mailing address
17709 OLD JEFFERSON HWY STE A, PRAIRIEVILLE, LA 70769-3977
(225) 677-8400
(225) 977-8484
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A09949
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1356400345
NPI
—
Enumeration date
05/31/2018
Last updated
05/31/2018
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