Provider Demographics
NPI:1356662100
Name:CORNERSTONE PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:CORNERSTONE PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:TRUITT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:225-677-5464
Mailing Address - Street 1:37390 PERKINS RD
Mailing Address - Street 2:SUITE J
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-3719
Mailing Address - Country:US
Mailing Address - Phone:225-677-5464
Mailing Address - Fax:225-677-5465
Practice Address - Street 1:37390 PERKINS RD
Practice Address - Street 2:SUITE J
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-3719
Practice Address - Country:US
Practice Address - Phone:225-677-5464
Practice Address - Fax:225-677-5465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-16
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA00514R174400000X
LAZ10770174400000X
LA07197174400000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty