Basic Information
| Provider Information | |||||||||
| NPI: | 1336445931 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | STEVENSON PHYSICAL THERAPY, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | STEVENSON & ASSOCIATES PHYSICAL THERAPY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15620 MCGREGOR BLVD | ||||||||
| Address2: | SUITE 115 | ||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339082528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2394546262 | ||||||||
| FaxNumber: | 2394540350 | ||||||||
| Practice Location | |||||||||
| Address1: | 6324 CORPORATE CT | ||||||||
| Address2: | |||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339193507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2394824459 | ||||||||
| FaxNumber: | 2394828396 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2011 | ||||||||
| LastUpdateDate: | 01/31/2011 | ||||||||
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| AuthorizedOfficialLastName: | STEVENSON | ||||||||
| AuthorizedOfficialFirstName: | ERIC | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2394546262 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | PT | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0400X | PT0002829 | FL | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation |
No ID Information.