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General NPI Number Information
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NPI Number | 1649719485
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Entity Type | Organization
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Legal Business Name | CORNERSTONE REHABILITATION OF SOUTHAVEN
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Dates
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Enumeration Date | 02/13/2017
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Last Update Date | 02/13/2017
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Provider Practice Location Address
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Address Line | 484 CHURCH RD E
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City | SOUTHAVEN
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State | MS
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Zip | 38671-9714
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Country | US
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Telephone | 662-349-2489
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Fax | 662-349-2966
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Provider Business Mailing Address
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Address Line | 50 S MAIN ST
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City | WATER VALLEY
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State | MS
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Zip | 38965-2946
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Country | US
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Telephone | 662-473-1667
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Fax | 662-473-2233
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MRS. THERESA H THOMPSON
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Credential |
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Telephone | 662-473-1667
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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 |
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License Number State |
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