MEDICARE: SUNSHINE THERAPY CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0401X	Comprehensive Outpatient Rehabilitation Facility (CORF)		FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	684595	OTHER	FL	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	GBP	OTHER	FL	BC/BS OF FLORID

General Provider Information

NPI Number	:	1023053394
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNSHINE THERAPY CENTER, INC.

Provider Business Mailing Address
First Line	:	6320 SAINT AUGUSTINE RD
Second Line	:	UNIT 1
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-2800
Country	:	US
Telephone Number	:	904-448-5075
Fax Number	:	904-636-7595

Provider Business Practice Location Address
First Line	:	6320 SAINT AUGUSTINE RD
Second Line	:	UNIT 1
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-2800
Country	:	US
Telephone Number	:	904-448-5075
Fax Number	:	904-636-7595

Authorized Official
Title or Position	:	PRESIDENT
Name	:	THADDEUS THOMPSON
Credential	:	PT
Telephone Number	:	904-448-5075

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	12/26/2014

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Directions to “SUNSHINE THERAPY CENTER, INC. ” Practice Location

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