Individual provider Active NPI

Deborah Cornish, PT

  • Physical Therapist
  • Albuquerque, NM
National Provider Identifier
1700918174
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
463 Issued in NM
Practice address
440 Jefferson St NE
Zia Es
Albuquerque, NM 87108-1235
Phone
(505) 255-7451
NPI assigned
Mar 12, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 463 NM Primary

Addresses

Primary practice location

440 Jefferson St NE
Zia Es
Albuquerque, NM 87108-1235

Mailing address

440 Jefferson St NE
Zia Es
Albuquerque, NM 87108-1235
Phone (505) 255-7451

Other identifiers 1

IdentifierTypeStateIssuer
L 6793MedicaidNM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

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

{
    "created_epoch": "1173657600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1700918174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "440 JEFFERSON ST NE",
            "address_2": "ZIA ES",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871081235",
            "telephone_number": "505-255-7451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "440 JEFFERSON ST NE",
            "address_2": "ZIA ES",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871081235",
            "telephone_number": "505-255-7451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORNISH",
        "first_name": "DEBORAH",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-12",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NM",
            "license": "463",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "L 6793",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.