Provider Demographics
NPI:1669688891
Name:NORTH BAY THERAPY LLC
Entity Type:Organization
Organization Name:NORTH BAY THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:GANEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, SCS, ATC
Authorized Official - Phone:228-385-9000
Mailing Address - Street 1:1990 POPPS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-2015
Mailing Address - Country:US
Mailing Address - Phone:228-385-9000
Mailing Address - Fax:228-388-1419
Practice Address - Street 1:1990 POPPS FERRY RD
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-2015
Practice Address - Country:US
Practice Address - Phone:228-385-9000
Practice Address - Fax:228-388-1419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT0841225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06008555Medicaid
MS06008555Medicaid
MS650000172Medicare PIN