Healthcare Provider Details

I. General information

NPI: 1417469065
Provider Name (Legal Business Name): NEWCORE PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2017
Last Update Date: 11/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5111 ABERCORN ST
SAVANNAH GA
31405-5214
US

IV. Provider business mailing address

PO BOX 15224
SAVANNAH GA
31416-1924
US

V. Phone/Fax

Practice location:
  • Phone: 912-239-6140
  • Fax: 912-335-3539
Mailing address:
  • Phone: 912-227-6962
  • Fax: 912-330-1070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. STUART M FIFE
Title or Position: CO-FOUNDER/CEO
Credential: PT
Phone: 912-239-6140