Healthcare Provider Details

I. General information

NPI: 1922297977
Provider Name (Legal Business Name): GULF COAST REHABILITATION AND WELLNESS CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2007
Last Update Date: 05/23/2023
Certification Date: 05/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6250 PARK BLVD
PINELLAS PARK FL
33781-3237
US

IV. Provider business mailing address

6250 PARK BLVD
PINELLAS PARK FL
33781-3237
US

V. Phone/Fax

Practice location:
  • Phone: 727-541-2520
  • Fax: 727-544-8971
Mailing address:
  • Phone: 727-541-2520
  • Fax: 727-544-8971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. KEVIN RONALD LEE
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 727-541-2520