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	:	1568468858
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEVENSON PHYSICAL THERAPY, INC.

Provider Business Mailing Address
First Line	:	2517 SANTA BARBARA BLVD
Second Line	:	UNIT 1
City	:	CAPE CORAL
State	:	FL
Zip	:	33914-4496
Country	:	US
Telephone Number	:	239-458-6600
Fax Number	:	239-458-6601

Provider Business Practice Location Address
First Line	:	2517 SANTA BARBARA BLVD
Second Line	:	UNIT 1
City	:	CAPE CORAL
State	:	FL
Zip	:	33914-4496
Country	:	US
Telephone Number	:	239-458-6600
Fax Number	:	239-458-6601

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	MR. ERIC WAYNE STEVENSON
Credential	:	PT
Telephone Number	:	239-458-6600

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	01/19/2011

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