Provider Demographics
NPI:1528359049
Name:CORNERSTONE REHAB, PLLC
Entity Type:Organization
Organization Name:CORNERSTONE REHAB, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TAIWO
Authorized Official - Middle Name:OLUWABUNMI
Authorized Official - Last Name:OGUNLEYE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:248-809-2853
Mailing Address - Street 1:17330 NORTHLAND PARK CT
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4318
Mailing Address - Country:US
Mailing Address - Phone:248-809-2853
Mailing Address - Fax:
Practice Address - Street 1:17330 NORTHLAND PARK CT
Practice Address - Street 2:SUITE 205
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4318
Practice Address - Country:US
Practice Address - Phone:248-809-2853
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-02
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501006445225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty