Healthcare Provider Details

I. General information

NPI: 1518689678
Provider Name (Legal Business Name): GULF COAST PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2022
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 HOSPITAL AVE
FRANKLIN LA
70538-3725
US

IV. Provider business mailing address

4750 SHERWOOD COMMON BLVD
BATON ROUGE LA
70816-4870
US

V. Phone/Fax

Practice location:
  • Phone: 337-828-3600
  • Fax:
Mailing address:
  • Phone: 208-541-7849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: KENNEDY STIBAL
Title or Position: ADMINISTRATOR
Credential:
Phone: 208-541-7849