Healthcare Provider Details

I. General information

NPI: 1093751539
Provider Name (Legal Business Name): CORNERSTONE REHABILITATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 10/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 S MAIN ST
WATER VALLEY MS
38965-2946
US

IV. Provider business mailing address

32 S MAIN ST
WATER VALLEY MS
38965-2946
US

V. Phone/Fax

Practice location:
  • Phone: 662-473-4777
  • Fax: 662-473-2233
Mailing address:
  • Phone: 662-473-3400
  • Fax: 662-473-4389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. CLAUDE S THOMPSON
Title or Position: OWNER
Credential:
Phone: 662-473-3400