Healthcare Provider Details

I. General information

NPI: 1215525118
Provider Name (Legal Business Name): PHYSICAL THERAPY CENTER OF OCEAN SPRINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2021
Last Update Date: 01/06/2021
Certification Date: 01/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 BROAD ST
COLUMBIA MS
39429-3404
US

IV. Provider business mailing address

900 HOLCOMB BLVD STE A
OCEAN SPRINGS MS
39564-3903
US

V. Phone/Fax

Practice location:
  • Phone: 601-444-0037
  • Fax: 601-444-0033
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DALE MICHAEL YAKE
Title or Position: CEO
Credential:
Phone: 678-403-3555