Healthcare Provider Details

I. General information

NPI: 1477633204
Provider Name (Legal Business Name): NATURE COAST REHABILITATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 01/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 SOUTH MAIN STREET, SUITE C
WILLISTON FL
32696-2548
US

IV. Provider business mailing address

25050 W NEWBERRY ROAD
NEWBERRY FL
32669-5050
US

V. Phone/Fax

Practice location:
  • Phone: 352-529-0012
  • Fax: 352-528-2878
Mailing address:
  • Phone: 352-472-1400
  • Fax: 352-472-1300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. ELIZABETH HICKS
Title or Position: OWNER
Credential: PT
Phone: 352-529-0012