Provider Demographics
NPI:1811044894
Name:GULF COAST THERAPY ASSOCIATES INC.
Entity Type:Organization
Organization Name:GULF COAST THERAPY ASSOCIATES INC.
Other - Org Name:AEGIS THERAPIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT - FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:BRITT
Authorized Official - Middle Name:
Authorized Official - Last Name:JEFFCOAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-372-6799
Mailing Address - Street 1:4933 OLD GREENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-6906
Mailing Address - Country:US
Mailing Address - Phone:479-201-6147
Mailing Address - Fax:479-401-2239
Practice Address - Street 1:2110 FLEISCHMANN RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-0562
Practice Address - Country:US
Practice Address - Phone:941-624-6222
Practice Address - Fax:941-624-6821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA6185224Z00000X
FLPT15960225100000X
FLOT11068225X00000X
FLOT1055225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLR6FOtherBCBS
FLR6FOtherBCBS
FL0441970001Medicare NSC