Randy Salvador Cornejo, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

ME41236 Issued in FL

Practice address

5690 Bollettieri Blvd
Bradenton, FL 34210-2211

Phone

(941) 739-7540

Fax

(941) 752-2626

NPI assigned

May 8, 2023

Last updated

Jul 24, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: randy.cornejo.1@19133.direct.athenahealth.com

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.

• Bonnette Elite Physical Therapy and Wellness

  • Physical Therapy Clinic/Center
  • Fort Worth, TX
  • NPI 1891141362

  Physical Therapist

  NPD

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

{
    "created_epoch": "1683504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721779200000",
    "number": "1811687478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7956 KLAMATH MOUNTAIN RD",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761374359",
            "telephone_number": "713-818-5924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5690 BOLLETTIERI BLVD",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342102211",
            "telephone_number": "941-739-7540",
            "fax_number": "941-752-2626"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6930 Harris Pkwy Ste 120",
            "address_purpose": "LOCATION",
            "city": "Fort Worth",
            "state": "TX",
            "postal_code": "761324272",
            "country_code": "US",
            "telephone_number": "817-885-0668",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CORNEJO",
        "first_name": "RANDY",
        "middle_name": "SALVADOR",
        "credential": "PT,  DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-05-08",
        "last_updated": "2024-07-24",
        "certification_date": "2024-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1375925",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "ME41236",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christopher Coppock, D.O.
• Joseph P Coppola, DO
• Lyn Corbitt, RPH
• Debra Corbo, PT
• Mariana B Cordova, PSY.D.
• Meredith Kindell Cornett, RMHCI
• Alexandra Dubois Corona, LCSW
• Dennis A Corona, D.D.S.
• Vincent Corona
• Raul A Correa, M.D.

• Physical Therapist in Bradenton, FL
• Providers in Bradenton, FL by specialty
• Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2024; 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.