NPIMap

Organization Active NPI

Great Strides Rehabilitation, Inc.

  • Developmental Therapist
  • Jacksonville, FL
National Provider Identifier
1659660157
Registry record updated Apr 5, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmental TherapistTaxonomy code 222Q00000X
Legal business name
GREAT STRIDES REHABILITATION, INC.
Practice address
12276 San Jose Blvd
Ste 508
Jacksonville, FL 32223-8628
Phone
(904) 886-3228
Fax
(904) 886-3297
NPI assigned
Apr 5, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jonathan Edenfield
Title
Owner / Occupational Therapist
Phone
(904) 886-3228

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Developmental TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 222Q00000X Primary

Addresses

Primary practice location

12276 San Jose Blvd
Ste 508
Jacksonville, FL 32223-8628

Mailing address

12276 San Jose Blvd
Ste 508
Jacksonville, FL 32223-8628
Phone (904) 886-3228

Other identifiers 1

IdentifierTypeStateIssuer
889662300MedicaidFL

National Provider Directory

National Provider Directory
Tax ID family
Great Strides Rehabilitation27 organizations share this tax ID, including this one

Other organizations with this tax ID 26

Organizations that report the same tax identification number in the National Provider Directory.

View all 26

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1301961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1301961600000",
    "number": "1659660157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12276 SAN JOSE BLVD",
            "address_2": "STE 508",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322238628",
            "telephone_number": "904-886-3228",
            "fax_number": "904-886-3297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12276 SAN JOSE BLVD",
            "address_2": "STE 508",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322238628",
            "telephone_number": "904-886-3228",
            "fax_number": "904-886-3297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT STRIDES REHABILITATION, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-05",
        "last_updated": "2011-04-05",
        "status": "A",
        "authorized_official_last_name": "EDENFIELD",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_title_or_position": "OWNER / OCCUPATIONAL THERAPIST",
        "authorized_official_telephone_number": "904-886-3228"
    },
    "taxonomies": [
        {
            "code": "222Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Developmental Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "889662300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.