Organization Name: | MAINSTREAM PHYSICAL THERAPY LLC |
NPI Number: | 1134292253 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RUSSELL WADE STEPHAN (OWNER PRESIDENT) |
Mailing Address: | 9371 Cypress Lake Dr Suite 20 Fort Myers |
State: | FL US |
Postal Code: | 339194939 |
Phone Number: | 2394152595 |
Fax Number: | 2394152597 |
NPI Enumeration Date: | 11/16/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |