Provider Demographics
NPI:1215992169
Name:CORMIER, JOHN KEVIN (PT)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:KEVIN
Last Name:CORMIER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2518 19TH ST E
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35404-4907
Mailing Address - Country:US
Mailing Address - Phone:205-507-0880
Mailing Address - Fax:
Practice Address - Street 1:526 14TH ST
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-3434
Practice Address - Country:US
Practice Address - Phone:205-345-4441
Practice Address - Fax:205-758-8880
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH1662225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL201201528OtherTRICARE
AL51522635OtherBLUE CROSS BLUE SHIELD
AL529923260Medicaid
AL51522635OtherBLUE CROSS BLUE SHIELD
AL201201528OtherTRICARE
AL529923260Medicaid