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General NPI Number Information
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NPI Number | 1023227436
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Entity Type | Organization
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Legal Business Name | GULF COAST THERAPY ASSOCIATES, P.A.
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3417 TAMIAMI TRL STE A
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-8158
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Country | US
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Telephone | 941-624-6222
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Fax | 941-624-6831
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Provider Business Mailing Address
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Address Line | 12576 BACCHUS RD
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City | PORT CHARLOTTE
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State | FL
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Zip | 33981-1509
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Country | US
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Telephone | 941-698-1191
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | MRS. THEESA C BENOCK
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Credential | O.T.R.C.H.T.
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Telephone | 941-624-6222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | OT1055
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License Number State | FL
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