Provider Demographics
NPI:1285716282
Name:GULF COAST PHYSICAL THERAPY CENTERS PA
Entity type:Organization
Organization Name:GULF COAST PHYSICAL THERAPY CENTERS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:N
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:228-864-1212
Mailing Address - Street 1:1721 MEDICAL PARK DR STE 102
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-2105
Mailing Address - Country:US
Mailing Address - Phone:228-396-3374
Mailing Address - Fax:228-396-3379
Practice Address - Street 1:1721 MEDICAL PARK DR STE 102
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-2105
Practice Address - Country:US
Practice Address - Phone:228-396-3374
Practice Address - Fax:228-936-3379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05225878Medicaid
MS05225878Medicaid