Healthcare Provider Details

I. General information

NPI: 1134387145
Provider Name (Legal Business Name): CORNERSTONE THERAPY CENTER & PRESCHOOL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43453 PARISH ST
SOUTH RIDING VA
20152-2522
US

IV. Provider business mailing address

43453 PARISH ST
SOUTH RIDING VA
20152-2522
US

V. Phone/Fax

Practice location:
  • Phone: 703-327-5323
  • Fax: 703-327-5323
Mailing address:
  • Phone: 703-327-5323
  • Fax: 703-327-5323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number2202003982
License Number StateVA

VIII. Authorized Official

Name: JENIFER MARY SHOCKLEY
Title or Position: SPEECH-LANGUAGE PATHOLOGIST
Credential: M.A., CCC-SLP, L
Phone: 703-327-5323