Provider Demographics
NPI:1417133679
Name:CORNERSTONE PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:CORNERSTONE PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SETH
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:FIBRAIO
Authorized Official - Suffix:
Authorized Official - Credentials:MPT, MTC, CSCS
Authorized Official - Phone:973-219-4208
Mailing Address - Street 1:600 JULIAN LN
Mailing Address - Street 2:SUITE 660
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-7813
Mailing Address - Country:US
Mailing Address - Phone:973-219-4208
Mailing Address - Fax:
Practice Address - Street 1:600 JULIAN LN
Practice Address - Street 2:SUITE 660
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704-7813
Practice Address - Country:US
Practice Address - Phone:973-219-4208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7200187Medicaid