Provider Demographics
NPI:1376651299
Name:COASTAL REHABILITATION OF SOUTH MISSISSIPPI
Entity Type:Organization
Organization Name:COASTAL REHABILITATION OF SOUTH MISSISSIPPI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAME
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:228-831-4646
Mailing Address - Street 1:15190 COMMUNITY RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-3485
Mailing Address - Country:US
Mailing Address - Phone:228-831-4646
Mailing Address - Fax:
Practice Address - Street 1:15190 COMMUNITY RD
Practice Address - Street 2:SUITE 110
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-3485
Practice Address - Country:US
Practice Address - Phone:228-831-4646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS6408090089OtherBCBS
MS08220738Medicaid
MS08220738Medicaid