Provider Demographics
NPI:1679718555
Name:CORNERSTONE PHYSICAL THERAPY
Entity type:Organization
Organization Name:CORNERSTONE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:S
Authorized Official - Last Name:REUSS
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:530-347-2220
Mailing Address - Street 1:PO BOX 980
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:96022-0980
Mailing Address - Country:US
Mailing Address - Phone:530-347-2220
Mailing Address - Fax:530-347-2227
Practice Address - Street 1:3254 MAIN STREET
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:CA
Practice Address - Zip Code:96022
Practice Address - Country:US
Practice Address - Phone:530-347-2220
Practice Address - Fax:530-347-2227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-08
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT25699225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT256991Medicare PIN