Healthcare Provider Details

I. General information

NPI: 1891654844
Provider Name (Legal Business Name): GREAT STRIDES REHABILITATION INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13123 KINGS LAKE DR UNIT 102
GIBSONTON FL
33534-3957
US

IV. Provider business mailing address

PO BOX 932184
ATLANTA GA
31193-2184
US

V. Phone/Fax

Practice location:
  • Phone: 904-886-3228
  • Fax: 904-404-7743
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMANDA STREETER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 800-699-9395