Healthcare Provider Details

I. General information

NPI: 1588710602
Provider Name (Legal Business Name): CORNERSTONE REHABILITATION SERVICES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 09/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3380 E MAIN ST
DANVILLE IN
46122-9089
US

IV. Provider business mailing address

3380 E MAIN ST
DANVILLE IN
46122-9089
US

V. Phone/Fax

Practice location:
  • Phone: 317-718-0089
  • Fax: 317-718-0097
Mailing address:
  • Phone: 317-718-0089
  • Fax: 317-718-0097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number53000049A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number53000049A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number53000049A
License Number StateIN

VIII. Authorized Official

Name: CARLA J GREGORY
Title or Position: PRESIDENT
Credential: P.T.
Phone: 317-718-0089