Provider Demographics
NPI:1700852357
Name:GULF COAST MED CTR PHYSICAL THERAPY
Entity Type:Organization
Organization Name:GULF COAST MED CTR PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITIES DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIENZA
Authorized Official - Suffix:
Authorized Official - Credentials:RN, LHRM, CCS-P
Authorized Official - Phone:727-868-2151
Mailing Address - Street 1:11528 US HIGHWAY 19
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-1442
Mailing Address - Country:US
Mailing Address - Phone:727-861-4770
Mailing Address - Fax:727-861-3351
Practice Address - Street 1:11528 US HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-1442
Practice Address - Country:US
Practice Address - Phone:727-861-4770
Practice Address - Fax:727-861-3351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-24
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL01589OtherUNIVERSAL HEALTH CARE
FLDE6703OtherRAILROAD MEDICARE
FL01589OtherUNIVERSAL HEALTH CARE