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General NPI Number Information
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NPI Number | 1780191601
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Entity Type | Organization
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Legal Business Name | CORNERSTONE PT ASSOCIATES,LLC
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Dates
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Enumeration Date | 12/30/2017
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Last Update Date | 12/30/2017
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Provider Practice Location Address
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Address Line | 64 FREETOWN RD STE 3
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City | RAYMOND
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State | NH
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Zip | 03077-2356
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Country | US
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Telephone | 603-895-6860
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Fax | 603-895-6861
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Provider Business Mailing Address
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Address Line | 64 FREETOWN RD STE 3
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City | RAYMOND
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State | NH
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Zip | 03077-2356
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Country | US
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Telephone | 603-895-6860
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Fax | 603-895-6861
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Authorized Official
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Title or Position | OWNER
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Name | JEFFREY MARK RICHARDS
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Credential | PT
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Telephone | 603-895-6860
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 0645
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License Number State | NH
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