Provider Demographics
NPI:1679628267
Name:CORNERSTONE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:CORNERSTONE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:OCHS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-623-4567
Mailing Address - Street 1:370 HIGHLAND PARK DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-3546
Mailing Address - Country:US
Mailing Address - Phone:859-623-4567
Mailing Address - Fax:859-623-7865
Practice Address - Street 1:370 HIGHLAND PARK DR
Practice Address - Street 2:SUITE 1
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-3546
Practice Address - Country:US
Practice Address - Phone:859-623-4567
Practice Address - Fax:859-623-7865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2009-08-27
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
KY9612Medicare ID - Type Unspecified