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General NPI Number Information
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NPI Number | 1487051702
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Entity Type | Organization
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Legal Business Name | CORNERSTONE SPORT & SPINE CENTER
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Dates
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Enumeration Date | 12/02/2014
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Last Update Date | 12/02/2014
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Provider Practice Location Address
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Address Line | 3008 HIGHWAY 178
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City | TUPELO
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State | MS
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Zip | 38804-8306
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Country | US
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Telephone | 662-841-5186
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Fax | 662-841-2667
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Provider Business Mailing Address
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Address Line | PO BOX 3065
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City | TUPELO
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State | MS
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Zip | 38803-3065
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Country | US
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Telephone | 662-841-5186
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Fax | 662-841-2667
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Authorized Official
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Title or Position | OWNER
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Name | MRS. LYNDA GAIL HESTER
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Credential | PT
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Telephone | 662-841-5186
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT1149
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License Number State | MS
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