Provider Demographics
NPI:1912270869
Name:GULF COAST SPINAL & NEUROSURGICAL SPECIALISTS LLC
Entity Type:Organization
Organization Name:GULF COAST SPINAL & NEUROSURGICAL SPECIALISTS LLC
Other - Org Name:PHYSICAL THERAPY DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:FAYARD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:228-875-4000
Mailing Address - Street 1:11010 DAVID ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-3481
Mailing Address - Country:US
Mailing Address - Phone:228-832-8327
Mailing Address - Fax:228-832-8328
Practice Address - Street 1:11010 DAVID ST
Practice Address - Street 2:SUITE B
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-3481
Practice Address - Country:US
Practice Address - Phone:228-832-8327
Practice Address - Fax:228-832-8328
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GULF COAST SPINAL & NEUROSURGICAL SPECIALISTS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty