MEDICARE: STEVENSON PHYSICAL THERAPY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0400X	Rehabilitation Clinic/Center	PT0002829	FL

General Provider Information

NPI Number	:	1336445931
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEVENSON PHYSICAL THERAPY, INC.

Provider Business Mailing Address
First Line	:	15620 MCGREGOR BLVD
Second Line	:	SUITE 115
City	:	FORT MYERS
State	:	FL
Zip	:	33908-2528
Country	:	US
Telephone Number	:	239-454-6262
Fax Number	:	239-454-0350

Provider Business Practice Location Address
First Line	:	6324 CORPORATE CT
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-3507
Country	:	US
Telephone Number	:	239-482-4459
Fax Number	:	239-482-8396

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ERIC W STEVENSON
Credential	:	PT
Telephone Number	:	239-454-6262

Provider Enumeration Date	:	01/31/2011
Last Update Date	:	01/31/2011

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