Provider Demographics
NPI:1710186853
Name:CORNERSTONE THERAPY & BALANCE CENTER LLC
Entity Type:Organization
Organization Name:CORNERSTONE THERAPY & BALANCE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:R
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:276-698-3104
Mailing Address - Street 1:25298 LEE HWY
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24211-7460
Mailing Address - Country:US
Mailing Address - Phone:276-698-3104
Mailing Address - Fax:
Practice Address - Street 1:25298 LEE HWY
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24211-7460
Practice Address - Country:US
Practice Address - Phone:276-698-3104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203632261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA193685OtherANTHEM BCBS
VATN0101OtherUNITED HEALTHCARE/JOHN DE
VAC09591OtherMEDICARE LEGACY PIN