Healthcare Provider Details

I. General information

NPI: 1568622595
Provider Name (Legal Business Name): CORNERSTONE REHAB SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2008
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 KINGSDALE CT
MITCHELLVILLE MD
20721-2019
US

IV. Provider business mailing address

1106 KINGSDALE CT
MITCHELLVILLE MD
20721-2019
US

V. Phone/Fax

Practice location:
  • Phone: 301-908-2812
  • Fax:
Mailing address:
  • Phone: 301-908-2812
  • Fax: 301-249-7444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number19575
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number03480
License Number StateMD

VIII. Authorized Official

Name: MISS DANA NIXON
Title or Position: CEO
Credential: OT
Phone: 301-908-2812