Provider Demographics
NPI:1922273507
Name:CORNERSTONE PEDIATRIC THERAPIES LLC
Entity Type:Organization
Organization Name:CORNERSTONE PEDIATRIC THERAPIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:STANFILL
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:931-801-5131
Mailing Address - Street 1:1989 MADISON ST
Mailing Address - Street 2:SUITE 122
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-5067
Mailing Address - Country:US
Mailing Address - Phone:931-538-3755
Mailing Address - Fax:931-538-3756
Practice Address - Street 1:1989 MADISON ST
Practice Address - Street 2:SUITE 122
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-5067
Practice Address - Country:US
Practice Address - Phone:931-538-3755
Practice Address - Fax:931-538-3756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2144174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty