Provider Demographics
NPI:1336445931
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
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:W
Authorized Official - Last Name:STEVENSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:239-454-6262
Mailing Address - Street 1:15620 MCGREGOR BLVD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-2528
Mailing Address - Country:US
Mailing Address - Phone:239-454-6262
Mailing Address - Fax:239-454-0350
Practice Address - Street 1:6324 CORPORATE CT
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-3507
Practice Address - Country:US
Practice Address - Phone:239-482-4459
Practice Address - Fax:239-482-8396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-31
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT0002829261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation