1043956790 NPI number — CORNERSTONE PHYSICAL THERAPY AND WELLNESS, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043956790 NPI number — CORNERSTONE PHYSICAL THERAPY AND WELLNESS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORNERSTONE PHYSICAL THERAPY AND WELLNESS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043956790
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
451 MORTON STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELKHART
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67950-1111
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
620-697-4331
Provider Business Mailing Address Fax Number:
620-697-4322

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
451 MORTON ST # 1111
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELKHART
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67950-5015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-697-4331
Provider Business Practice Location Address Fax Number:
620-697-4322
Provider Enumeration Date:
05/06/2022

Additional Information

Authorized Official

Authorized Official Last Name:
ARANDA
Authorized Official First Name:
AMANDA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
580-817-0082

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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