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Organization
MAINSTREAM PHYSICAL THERAPY LLC
Active
Organization
MAINSTREAM PHYSICAL THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RUSSELL WADE STEPHAN MSM MPT (OWNER PRESIDENT)
(239) 415-2595
Entity
Organization
Contact information
Practice address
9371 CYPRESS LAKE DR, SUITE 20, FORT MYERS, FL 33919-4939
(239) 415-2595
(239) 415-2597
Mailing address
9371 CYPRESS LAKE DR, SUITE 20, FORT MYERS, FL 33919-4939
(239) 415-2595
(239) 415-2597
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
11/16/2006
Last updated
08/22/2020
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