Healthcare Provider Details

I. General information

NPI: 1699183145
Provider Name (Legal Business Name): GULF COAST PHYSICAL MEDICINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2014
Last Update Date: 01/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8800 KATY FWY SUITE 105
HOUSTON TX
77024-1633
US

IV. Provider business mailing address

8800 KATY FWY STE 105
HOUSTON TX
77024-1645
US

V. Phone/Fax

Practice location:
  • Phone: 832-831-8656
  • Fax:
Mailing address:
  • Phone: 832-831-8656
  • Fax: 832-831-8674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. KANON FRANK OSWALD
Title or Position: OWNER
Credential: D.C.
Phone: 281-948-4111