Provider Demographics
NPI:1871199141
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:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:T
Authorized Official - Last Name:FREI
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:970-310-4524
Mailing Address - Street 1:2129 HAUGEN ST
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-9403
Mailing Address - Country:US
Mailing Address - Phone:970-310-4524
Mailing Address - Fax:
Practice Address - Street 1:2129 HAUGEN ST
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-9403
Practice Address - Country:US
Practice Address - Phone:970-310-4524
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-10
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty