Provider Demographics
NPI:1497860019
Name:NATURE COAST PHYSICAL THERAPY &
Entity Type:Organization
Organization Name:NATURE COAST PHYSICAL THERAPY &
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KETTENACKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-726-3950
Mailing Address - Street 1:3787 E GULF TO LAKE HWY
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34453-3204
Mailing Address - Country:US
Mailing Address - Phone:352-341-1101
Mailing Address - Fax:352-726-7582
Practice Address - Street 1:3787 E GULF TO LAKE HWY
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34453-3204
Practice Address - Country:US
Practice Address - Phone:352-341-1101
Practice Address - Fax:352-726-7582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT9294261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106924Medicare ID - Type Unspecified