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Organization
GREAT STRIDES REHABILITATION, INC.
Active
Organization
GREAT STRIDES REHABILITATION, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN EDENFIELD (OWNER / OCCUPATIONAL THERAPIST)
(904) 886-3228
Entity
Organization
Contact information
Practice address
12276 SAN JOSE BLVD, STE 508, JACKSONVILLE, FL 32223-8628
(904) 886-3228
(904) 886-3297
Mailing address
12276 SAN JOSE BLVD, STE 508, JACKSONVILLE, FL 32223-8628
(904) 886-3228
(904) 886-3297
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
889662300
—
FL
Enumeration date
04/05/2011
Last updated
04/05/2011
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