Healthcare Provider Details

I. General information

NPI: 1871574426
Provider Name (Legal Business Name): FIRSTCHOICE PHYSICAL THERAPY AND SPORTS REHABILTATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11945 SAN JOSE BLVD SUITE 202
JACKSONVILLE FL
32223-1613
US

IV. Provider business mailing address

11945 SAN JOSE BLVD SUITE 202
JACKSONVILLE FL
32223-1613
US

V. Phone/Fax

Practice location:
  • Phone: 904-880-2424
  • Fax: 904-880-2420
Mailing address:
  • Phone: 904-880-2424
  • Fax: 904-880-2420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberHCC1264
License Number StateFL

VIII. Authorized Official

Name: MR. GERALD ALLEN STEVENS
Title or Position: PRESIDENT/ OWNER
Credential: ATC, LAT
Phone: 904-880-2424