Healthcare Provider Details

I. General information

NPI: 1104799105
Provider Name (Legal Business Name): GULF BIOMECHANICAL LABORATORY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2025
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 MORGAN AVE
CORPUS CHRISTI TX
78405-1948
US

IV. Provider business mailing address

8801 TRADEWAY ST
SAN ANTONIO TX
78217-6114
US

V. Phone/Fax

Practice location:
  • Phone: 361-299-5983
  • Fax: 361-299-5984
Mailing address:
  • Phone: 210-495-3399
  • Fax: 210-495-3393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: KATHY A MYERS
Title or Position: REPRESENTATIVE
Credential:
Phone: 210-859-1288