Provider Demographics
NPI:1659338135
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:352-528-0022
Mailing Address - Fax:352-528-2878
Practice Address - Street 1:37 S MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:FL
Practice Address - Zip Code:32696-2681
Practice Address - Country:US
Practice Address - Phone:352-528-0022
Practice Address - Fax:352-528-2878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-27
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL890647500Medicaid
FLY911YOtherPHYSICAL THERAPY-BCBS
FLK3936Medicare ID - Type UnspecifiedPHYSICAL THERAPY