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General NPI Number Information
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NPI Number | 1184146599
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Entity Type | Organization
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Legal Business Name | CORNERSTONE PHYSICAL THERAPY
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Dates
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Enumeration Date | 07/07/2017
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Last Update Date | 07/07/2017
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Provider Practice Location Address
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Address Line | 1570 W GRAND AVE
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City | GROVER BEACH
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State | CA
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Zip | 93433-2261
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Country | US
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Telephone | 805-473-0555
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Fax | 888-572-9170
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Provider Business Mailing Address
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Address Line | 460 S 13TH ST
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City | GROVER BEACH
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State | CA
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Zip | 93433-2535
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Country | US
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Telephone | 805-473-0555
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Fax | 888-572-9170
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Authorized Official
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Title or Position | OWNER
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Name | MR. JEFF PAUL MILLER
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Credential | PT
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Telephone | 805-473-0555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT24124
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License Number State | CA
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