Provider Demographics
NPI:1972649788
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:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:SALL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:205-822-8335
Mailing Address - Street 1:2870 OLD ROCKY RIDGE RD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243-2927
Mailing Address - Country:US
Mailing Address - Phone:205-822-8335
Mailing Address - Fax:205-822-8337
Practice Address - Street 1:2870 OLD ROCKY RIDGE RD
Practice Address - Street 2:SUITE 115
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243-2927
Practice Address - Country:US
Practice Address - Phone:205-822-8335
Practice Address - Fax:205-822-8337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0007753741OtherAETNA
ALBCBSOther515-23555
ALBCBSOther515-23555
AL=========OtherVIVA
AL0007753741OtherAETNA