Provider Demographics
NPI:1538104153
Name:CORNERSTONE REHABILITATION OF OXFORD, INC
Entity Type:Organization
Organization Name:CORNERSTONE REHABILITATION OF OXFORD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:C
Authorized Official - Last Name:SHINALL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:662-238-2800
Mailing Address - Street 1:PO BOX 1016
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-5221
Mailing Address - Country:US
Mailing Address - Phone:662-238-2800
Mailing Address - Fax:662-238-2808
Practice Address - Street 1:2205 JEFFERSON DAVIS DR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5221
Practice Address - Country:US
Practice Address - Phone:662-238-2800
Practice Address - Fax:662-238-2808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09015451Medicaid
MS09015451Medicaid