Provider Demographics
NPI:1093897001
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 1:926 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:PASCAGOULA
Mailing Address - State:MS
Mailing Address - Zip Code:39567-4345
Mailing Address - Country:US
Mailing Address - Phone:228-762-0151
Mailing Address - Fax:228-762-0171
Practice Address - Street 1:926 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39567-4345
Practice Address - Country:US
Practice Address - Phone:228-762-0151
Practice Address - Fax:228-762-0171
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
MS0915734Medicaid
MS0915734Medicaid