Provider Demographics
NPI:1417469065
Name:NEWCORE PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:NEWCORE PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:M
Authorized Official - Last Name:FIFE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:912-239-6140
Mailing Address - Street 1:PO BOX 15224
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31416-1924
Mailing Address - Country:US
Mailing Address - Phone:912-227-6962
Mailing Address - Fax:912-330-1070
Practice Address - Street 1:5111 ABERCORN ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-5214
Practice Address - Country:US
Practice Address - Phone:912-239-6140
Practice Address - Fax:912-335-3539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-03
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Single Specialty