Provider Demographics
NPI:1356693816
Name:CORNERSTONE PELVIC HEALTH AND WELLNESS, PLLC
Entity type:Organization
Organization Name:CORNERSTONE PELVIC HEALTH AND WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LEGRAND
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:859-543-0319
Mailing Address - Street 1:1100 GLENSBORO RD STE 7
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40342-9084
Mailing Address - Country:US
Mailing Address - Phone:859-543-0319
Mailing Address - Fax:859-543-2895
Practice Address - Street 1:1100 GLENSBORO RD STE 7
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:KY
Practice Address - Zip Code:40342-9084
Practice Address - Country:US
Practice Address - Phone:859-543-0319
Practice Address - Fax:859-543-2895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-09
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY003742261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0798504Medicare PIN