Provider Demographics
NPI:1962739722
Name:COASTAL PLAINS INTERAGENCY COORDINATING COUNCIL
Entity type:Organization
Organization Name:COASTAL PLAINS INTERAGENCY COORDINATING COUNCIL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRPERSON
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:BURCHFIELD
Authorized Official - Last Name:ROWE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:228-896-2824
Mailing Address - Street 1:4063 GINGER DRIE
Mailing Address - Street 2:SUITE A
Mailing Address - City:D'LBERVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39540-3705
Mailing Address - Country:US
Mailing Address - Phone:228-896-2824
Mailing Address - Fax:228-896-2825
Practice Address - Street 1:4063 GINGER DRIE
Practice Address - Street 2:SUITE A
Practice Address - City:D'LBERVILLE
Practice Address - State:MS
Practice Address - Zip Code:39540-3705
Practice Address - Country:US
Practice Address - Phone:228-896-2824
Practice Address - Fax:228-896-2825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-15
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT03992251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty