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Organization

GCOC PHYSICAL THERAPY

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. LISA DAWN HANSHEW CPC (BUSINESS MANAGER)
(727) 868-9563
Entity
Organization

Contact information

Practice address
7315 HUDSON AVE, HUDSON, FL 34667-1158
(727) 868-9563
(727) 869-6909
Mailing address
PO BOX 5515, HUDSON, FL 34674-5515
(727) 868-9563
(727) 869-6909

Taxonomy

Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
ME0038324
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1060673200
DEPT OF LABOR
FL
01
Q56
BLUE CROSS BLUE SHIELD
FL
Enumeration date
01/23/2007
Last updated
06/27/2008
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