Healthcare Provider Details

I. General information

NPI: 1669478152
Provider Name (Legal Business Name): CORNERSTONE FITNESS AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 BAKER AVE
CLANTON AL
35045-2337
US

IV. Provider business mailing address

PO DRAWER 1200 110 BAKER AVE
CLANTON AL
35046
US

V. Phone/Fax

Practice location:
  • Phone: 205-280-6450
  • Fax: 205-280-6451
Mailing address:
  • Phone: 205-280-6450
  • Fax: 205-280-6451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number10682
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number10682
License Number StateAL

VIII. Authorized Official

Name: MRS. ANDREA WEST
Title or Position: BILLING MANAGER
Credential:
Phone: 205-280-6450