Provider Demographics
NPI:1679663215
Name:CORNERSTONE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:CORNERSTONE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RAUSER
Authorized Official - Suffix:
Authorized Official - Credentials:BMR, PT, MTC
Authorized Official - Phone:719-596-5000
Mailing Address - Street 1:2140 ACADEMY CIR
Mailing Address - Street 2:SUITE A
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1690
Mailing Address - Country:US
Mailing Address - Phone:719-596-5000
Mailing Address - Fax:719-596-0890
Practice Address - Street 1:2140 ACADEMY CIR
Practice Address - Street 2:SUITE A
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1690
Practice Address - Country:US
Practice Address - Phone:719-596-5000
Practice Address - Fax:719-596-0890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-08-22
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
COC547198Medicare ID - Type Unspecified