Stephen Cornelison, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

2001015505 Issued in MO

Practice address

1501 Tidewater Dr
Columbia, MO 65202-6425

Phone

(573) 442-9728

NPI assigned

Apr 24, 2007

Sex

Male

Sole proprietor

Yes

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

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

{
    "created_epoch": "1177372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211414400000",
    "number": "1194944629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 TIDEWATER DR",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652026425",
            "telephone_number": "573-489-2714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 TIDEWATER DR",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652026425",
            "telephone_number": "573-442-9728"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORNELISON",
        "first_name": "STEPHEN",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-24",
        "last_updated": "2008-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MO",
            "license": "2001015505",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Taylor D Cordonnier, MD
• David R Cordry, O.D.
• Bethany L Corey, PA
• Jason Anthony Corey, CRNA
• Matthew Philip Cormier, DO
• Dan E. Cornell, R.PH.
• Cornerstone Caregiving East LLC
• Cornerstone Compassionate Care Services
• Elizabeth Costello, RD, LD
• Paul B Cotner, DMD

• Physical Therapy Assistant in Columbia, MO
• Providers in Columbia, MO by specialty
• Physical Therapy Assistant in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2008; 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.