Provider Demographics
NPI:1184934614
Name:KORNHAUS, KATHRYN H (AP, DOM)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:H
Last Name:KORNHAUS
Suffix:
Gender:F
Credentials:AP, DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 E OLYMPIA AVE
Mailing Address - Street 2:SUITE 246
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-3823
Mailing Address - Country:US
Mailing Address - Phone:941-575-6645
Mailing Address - Fax:
Practice Address - Street 1:315 E OLYMPIA AVE
Practice Address - Street 2:SUITE 246
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-3823
Practice Address - Country:US
Practice Address - Phone:941-575-6645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-18
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1361171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist