Provider Demographics
NPI:1386085041
Name:GULF COAST THERAPY
Entity type:Organization
Organization Name:GULF COAST THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SLP/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:BONOMO
Authorized Official - Suffix:
Authorized Official - Credentials:MS/SLP/CCC
Authorized Official - Phone:409-242-6500
Mailing Address - Street 1:PO BOX 57
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77553-0057
Mailing Address - Country:US
Mailing Address - Phone:409-242-6500
Mailing Address - Fax:409-497-4389
Practice Address - Street 1:928 BROADWAY
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77550
Practice Address - Country:US
Practice Address - Phone:409-242-6500
Practice Address - Fax:409-497-4389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-10
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103159235Z00000X
TX105339235Z00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty