Provider Demographics
NPI:1376582452
Name:FIRSTCHOICE PHYSICAL THERAPY AND SPORTS REHABILITATION INC
Entity Type:Organization
Organization Name:FIRSTCHOICE PHYSICAL THERAPY AND SPORTS REHABILITATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:ATC LAT
Authorized Official - Phone:904-880-2424
Mailing Address - Street 1:11945 SAN JOSE BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-1613
Mailing Address - Country:US
Mailing Address - Phone:904-880-2424
Mailing Address - Fax:904-880-2420
Practice Address - Street 1:11945 SAN JOSE BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223
Practice Address - Country:US
Practice Address - Phone:904-880-2424
Practice Address - Fax:904-880-2420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC1264261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6617Medicare ID - Type Unspecified