Premier Therapy, LLC

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

1404 Issued in AL

Legal business name

PREMIER THERAPY, LLC

Practice address

213 38TH St NE
Fort Payne, AL 35967-3909

Phone

(256) 844-2992

NPI assigned

Sep 21, 2006

Organization subpart

No

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

Authorized official

Name

Kim H Cornelius, MS CCCSLP

Title

President

Phone

(256) 844-2992

Specialties & licenses 2

Addresses

Other identifiers 2

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

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422921600000",
    "number": "1720187115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "213 38TH ST NE",
            "city": "FORT PAYNE",
            "state": "AL",
            "postal_code": "359673909",
            "telephone_number": "256-844-2992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "213 38TH ST NE",
            "city": "FORT PAYNE",
            "state": "AL",
            "postal_code": "359673909",
            "telephone_number": "256-844-2992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-21",
        "last_updated": "2015-02-03",
        "status": "A",
        "authorized_official_last_name": "CORNELIUS",
        "authorized_official_first_name": "KIM",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "256-844-2992",
        "authorized_official_credential": "MS CCCSLP"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "AL",
            "license": "17240",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "AL",
            "license": "1404",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "529920120",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890017380",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katelynn Pettis, OTR/L
• Elizabeth Phillips, PT
• Lisa Diane Pierce, BS PHARM
• Tomas Quiambao Pineda,Jr., M.D.
• Emily Shirey Poff, LPC
• Prohealth Physical Therapy
• Prohealth Physical Therapy, LLC
• Provision Health Services, LLC
• Debra Eaine Puckett, OTL
• Anna Lee Putman

• Speech-Language Pathologist in Fort Payne, AL
• Providers in Fort Payne, AL by specialty
• Speech-Language Pathologist in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2015; 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.