Provider Demographics
NPI:1609833185
Name:NATURE COAST REHABILITATION INC
Entity Type:Organization
Organization Name:NATURE COAST REHABILITATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:JOHNSON
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:352-528-0022
Mailing Address - Street 1:PO BOX 518
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:FL
Mailing Address - Zip Code:32696-0518
Mailing Address - Country:US
Mailing Address - Phone:352-493-2999
Mailing Address - Fax:352-493-0026
Practice Address - Street 1:1315 NW 21ST AVE
Practice Address - Street 2:
Practice Address - City:CHIEFLAND
Practice Address - State:FL
Practice Address - Zip Code:32626-1959
Practice Address - Country:US
Practice Address - Phone:352-493-2999
Practice Address - Fax:352-493-0026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-27
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY915GOtherPHYSICAL THERAPY-BCBS
FL890647500Medicaid
FL890647500Medicaid