Provider Demographics
NPI:1023244738
Name:CORNERSTONE PHYSICAL THERAPY HEALTH AND WELLNESS CENTER, PC
Entity type:Organization
Organization Name:CORNERSTONE PHYSICAL THERAPY HEALTH AND WELLNESS CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LA FUENTE
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, CSCS
Authorized Official - Phone:732-499-4540
Mailing Address - Street 1:77 BRANT AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-1560
Mailing Address - Country:US
Mailing Address - Phone:732-499-4540
Mailing Address - Fax:732-499-4577
Practice Address - Street 1:77 BRANT AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:CLARK
Practice Address - State:NJ
Practice Address - Zip Code:07066-1560
Practice Address - Country:US
Practice Address - Phone:732-499-4540
Practice Address - Fax:732-499-4577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-09
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy