Provider Demographics
NPI:1568468858
Name:STEVENSON PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:STEVENSON PHYSICAL THERAPY, INC.
Other - Org Name:STEVENSON & ASSOCIATES PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:STEVENSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:239-458-6600
Mailing Address - Street 1:2517 SANTA BARBARA BLVD
Mailing Address - Street 2:UNIT 1
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-4496
Mailing Address - Country:US
Mailing Address - Phone:239-458-6600
Mailing Address - Fax:239-458-6601
Practice Address - Street 1:2517 SANTA BARBARA BLVD
Practice Address - Street 2:UNIT 1
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33914-4496
Practice Address - Country:US
Practice Address - Phone:239-458-6600
Practice Address - Fax:239-458-6601
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEVENSON PHYSICAL THERAPY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-22
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT0002829261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106848Medicare UPIN