MEDICARE: STEPHANIE LYNN FORAKER DPT

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	225100000X	Physical Therapist	2305206815	VA
2	225100000X	Physical Therapist	P20025	NC
3	225100000X	Physical Therapist	PT28730	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598062853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE LYNN FORAKER DPT

Provider Business Mailing Address
First Line	:	445 STATE ROAD 13 N STE 21
Second Line	:
City	:	FRUIT COVE
State	:	FL
Zip	:	32259-2824
Country	:	US
Telephone Number	:	904-239-5715
Fax Number	:

Provider Business Practice Location Address
First Line	:	445 STATE ROAD 13 N STE 21
Second Line	:
City	:	FRUIT COVE
State	:	FL
Zip	:	32259-2824
Country	:	US
Telephone Number	:	904-239-5715
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2011
Last Update Date	:	09/01/2023

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