Provider Demographics
NPI:1053691253
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:228-822-9066
Mailing Address - Street 1:PO BOX 3238
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39505-3238
Mailing Address - Country:US
Mailing Address - Phone:228-822-9066
Mailing Address - Fax:228-822-9722
Practice Address - Street 1:1025 DIVISION ST STE A
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39530-2910
Practice Address - Country:US
Practice Address - Phone:228-267-3582
Practice Address - Fax:228-822-9722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-19
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
C02488Medicare PIN