Healthcare Provider Details

I. General information

NPI: 1730388554
Provider Name (Legal Business Name): GULF COAST REHABILITATION, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1706 BIENVILLE BLVD
OCEAN SPRINGS MS
39564-3073
US

IV. Provider business mailing address

PO BOX 605
OCEAN SPRINGS MS
39566-0605
US

V. Phone/Fax

Practice location:
  • Phone: 228-818-9164
  • Fax: 228-818-9167
Mailing address:
  • Phone: 228-818-9164
  • Fax: 228-818-9167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT3521
License Number StateMS

VIII. Authorized Official

Name: MISS JOCELYN ALLEEN MAYFIELD
Title or Position: PRESIDENT
Credential: MPT, OTR/L
Phone: 228-818-9164