Provider Demographics
NPI:1720551435
Name:CORNERSTONE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:CORNERSTONE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:301-732-4754
Mailing Address - Street 1:5300 WESTVIEW DR STE 108
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-8372
Mailing Address - Country:US
Mailing Address - Phone:301-732-4754
Mailing Address - Fax:
Practice Address - Street 1:5300 WESTVIEW DR STE 108
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-8372
Practice Address - Country:US
Practice Address - Phone:301-732-4754
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-04
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty