Dakota Rose Cornelius

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

014046 Issued in AZ

Practice address

18540 E San Tan Blvd Ste 101
Queen Creek, AZ 85142-2203

Phone

(480) 677-8202

Fax

(480) 677-8203

NPI assigned

Dec 9, 2019

Last updated

Dec 9, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dash Physical Therapy LLC

  • Physical Therapist
  • Queen Creek, AZ
  • NPI 1407345523
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1575849600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575849600000",
    "number": "1073150090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18540 E SAN TAN BLVD STE 101",
            "city": "QUEEN CREEK",
            "state": "AZ",
            "postal_code": "851422203",
            "telephone_number": "480-677-8202",
            "fax_number": "480-677-8203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18540 E SAN TAN BLVD STE 101",
            "city": "QUEEN CREEK",
            "state": "AZ",
            "postal_code": "851422203",
            "telephone_number": "480-677-8202",
            "fax_number": "480-677-8203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORNELIUS",
        "first_name": "DAKOTA",
        "middle_name": "ROSE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-12-09",
        "last_updated": "2019-12-09",
        "certification_date": "2019-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "AZ",
            "license": "014046",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew Alexander Cook, FNP
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• Physical Therapy Assistant in Queen Creek, AZ
• Providers in Queen Creek, AZ by specialty
• Physical Therapy Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.