Provider Demographics
NPI:1285886457
Name:CORNATZER, ANGELA CORNATZER (PTA)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:CORNATZER
Last Name:CORNATZER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:C
Other - Last Name:BLACKWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3127 PIGNATELLI CRES
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-8058
Mailing Address - Country:US
Mailing Address - Phone:843-971-7078
Mailing Address - Fax:
Practice Address - Street 1:3301 STOCKDALE ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-7125
Practice Address - Country:US
Practice Address - Phone:843-375-5448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-18
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1994261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy