Healthcare Provider Details

I. General information

NPI: 1649719485
Provider Name (Legal Business Name): CORNERSTONE REHABILITATION OF SOUTHAVEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2017
Last Update Date: 02/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

484 CHURCH RD E
SOUTHAVEN MS
38671-9714
US

IV. Provider business mailing address

50 S MAIN ST
WATER VALLEY MS
38965-2946
US

V. Phone/Fax

Practice location:
  • Phone: 662-349-2489
  • Fax: 662-349-2966
Mailing address:
  • Phone: 662-473-1667
  • Fax: 662-473-2233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. THERESA H THOMPSON
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 662-473-1667