Provider Demographics
NPI:1215525118
Name:PHYSICAL THERAPY CENTER OF OCEAN SPRINGS LLC
Entity type:Organization
Organization Name:PHYSICAL THERAPY CENTER OF OCEAN SPRINGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:YAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-403-3555
Mailing Address - Street 1:900 HOLCOMB BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-3903
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:433 BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MS
Practice Address - Zip Code:39429-3404
Practice Address - Country:US
Practice Address - Phone:601-444-0037
Practice Address - Fax:601-444-0033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty