MEDICARE: GREAT STRIDES REHABILITATION INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	103T00000X	Psychologist
2	2251P0200X	Pediatric Physical Therapist
3	225XP0200X	Pediatric Occupational Therapist
4	235Z00000X	Speech-Language Pathologist
5	261Q00000X	Clinic/Center
6	174400000X	Specialist

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	:	1942226493
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREAT STRIDES REHABILITATION INC.

Provider Business Mailing Address
First Line	:	PO BOX 932184
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	31193-2184
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12276 SAN JOSE BLVD STE 508
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-8618
Country	:	US
Telephone Number	:	904-886-3228
Fax Number	:	904-404-7743

Authorized Official
Title or Position	:	CHIEF ADMINISTRATIVE OFFICER
Name	:	AMANDA STREETER
Credential	:
Telephone Number	:	800-699-9395

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	07/01/2025

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