Provider Demographics
NPI:1518266543
Name:CORBETT PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:CORBETT PHYSICAL THERAPY LLC
Other - Org Name:CORNERSTONE PHYSICAL THERAPY AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:STALLINGS
Authorized Official - Suffix:III
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:843-837-1930
Mailing Address - Street 1:25 PEARCE RD
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-9353
Mailing Address - Country:US
Mailing Address - Phone:843-837-1930
Mailing Address - Fax:843-837-1931
Practice Address - Street 1:25 PEARCE RD
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-9353
Practice Address - Country:US
Practice Address - Phone:843-837-1930
Practice Address - Fax:843-837-1931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-16
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5842225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty