Provider Demographics
NPI:1558772541
Name:CAMERON THERAPIES, LLC
Entity Type:Organization
Organization Name:CAMERON THERAPIES, LLC
Other - Org Name:CORNERSTONE THERAPIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:W
Authorized Official - Last Name:CAMERON
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:806-928-2436
Mailing Address - Street 1:501 MONTICELLO PARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:PORTALES
Mailing Address - State:NM
Mailing Address - Zip Code:88130-8200
Mailing Address - Country:US
Mailing Address - Phone:806-928-2436
Mailing Address - Fax:
Practice Address - Street 1:809 PARKLAND DR
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-4474
Practice Address - Country:US
Practice Address - Phone:806-928-2436
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAMERON THERAPIES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-05-13
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM32922251P0200X
NM1525225XP0200X
NM5169235Z00000X
NM5171235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty