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General NPI Number Information
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NPI Number | 1548266836
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Entity Type | Organization
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Legal Business Name | STEVENSON PHYSICAL THERAPY, INC.
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Dates
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Enumeration Date | 06/22/2005
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Last Update Date | 01/11/2010
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Provider Practice Location Address
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Address Line | 15620 MCGREGOR BLVD SUITE 115
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City | FORT MYERS
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State | FL
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Zip | 33908-2528
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Country | US
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Telephone | 239-454-6262
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Fax | 239-454-0350
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Provider Business Mailing Address
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Address Line | 15620 MCGREGOR BLVD SUITE 115
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City | FORT MYERS
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State | FL
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Zip | 33908-2528
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Country | US
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Telephone | 239-454-6262
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Fax | 239-454-0350
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MR. ERIC WAYNE STEVENSON
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Credential | PT
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Telephone | 239-454-6262
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | PT0002829
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License Number State | FL
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