Provider Demographics
NPI:1710196423
Name:GULF COAST CHIROPRACTIC AND PHYSICAL THERAPY CENTER, PA
Entity Type:Organization
Organization Name:GULF COAST CHIROPRACTIC AND PHYSICAL THERAPY CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOSHES
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPT, DC, CCSP
Authorized Official - Phone:941-927-7463
Mailing Address - Street 1:2426 BEE RIDGE RD STE C
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-6350
Mailing Address - Country:US
Mailing Address - Phone:941-927-7463
Mailing Address - Fax:941-927-5522
Practice Address - Street 1:2426 BEE RIDGE RD STE C
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-6350
Practice Address - Country:US
Practice Address - Phone:941-927-7463
Practice Address - Fax:941-927-5522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4610111N00000X
FLCH4148111N00000X
FLCH7137111N00000X
FLPT2352225100000X
CTPT2252225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCH9933OtherRAILROAD MEDICARE
FL45344OtherBC AND BS
FLCH9933OtherRAILROAD MEDICARE