Healthcare Provider Details

I. General information

NPI: 1659338135
Provider Name (Legal Business Name): NATURE COAST REHABILITATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 01/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 S MAIN ST STE C
WILLISTON FL
32696-2681
US

IV. Provider business mailing address

PO BOX 518
WILLISTON FL
32696-0518
US

V. Phone/Fax

Practice location:
  • Phone: 352-528-0022
  • Fax: 352-528-2878
Mailing address:
  • Phone: 352-528-0022
  • Fax: 352-528-2878

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: MS. ELIZABETH JOHNSON HICKS
Title or Position: OWNER/PRESIDENT
Credential: PT
Phone: 352-528-0022