Provider Demographics
NPI:1962210260
Name:SORDELET, CORTNEY ELLA
Entity type:Individual
Prefix:
First Name:CORTNEY
Middle Name:ELLA
Last Name:SORDELET
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CORTNEY
Other - Middle Name:ELLA
Other - Last Name:GARNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:200 MELBOURNE WAY
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30721-9261
Mailing Address - Country:US
Mailing Address - Phone:706-260-5992
Mailing Address - Fax:
Practice Address - Street 1:1729 E MORRIS ST STE 5
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30721-0255
Practice Address - Country:US
Practice Address - Phone:706-260-5992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006004225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist