Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Cornelius Liclic, LPTA

Individual provider Physical Therapist · NPI 1417686494

Cornelius Liclic, LPTA is a Physical Therapist in Gainesville, Virginia. Practices as a sole proprietor. Licensed in Virginia.

Licensed in
VA
In the registry since
2022

Practice location Address checks out

7501 Heritage Village Plz
Gainesville, VA 20155-3078
Phone: (210) 542-5623
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence 2306604819 (VA)

Record details

NPI number1417686494
Entity typeIndividual (Type 1)
GenderMale
Credentials LPTA
Sole proprietorYes
NPI enumeratedJune 6, 2022
Last updated in NPPESJune 6, 2022
Certification dateMay 25, 2022
Mailing address12507 Quarterhorse Ln, Woodbridge, VA 22192-6371

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