Provider Demographics
NPI:1760427975
Name:FCHR PA
Entity Type:Organization
Organization Name:FCHR PA
Other - Org Name:FOUR CORNERS HEALTH & REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:T
Authorized Official - Last Name:KRON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:352-243-9341
Mailing Address - Street 1:PO BOX 135366
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34713-5366
Mailing Address - Country:US
Mailing Address - Phone:352-243-9341
Mailing Address - Fax:352-243-8293
Practice Address - Street 1:627 8TH ST
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-2159
Practice Address - Country:US
Practice Address - Phone:352-243-4422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT20389225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY911QOtherBLUE CROSS BLUE SHIELD
FLK7079Medicare ID - Type Unspecified