=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285716282
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GULF COAST PHYSICAL THERAPY CENTERS PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/19/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1721 MEDICAL PARK DR STE 102
-----------------------------------------------------
City | BILOXI
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39532-2105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 228-396-3374
-----------------------------------------------------
Fax | 228-936-3379
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1721 MEDICAL PARK DR STE 102
-----------------------------------------------------
City | BILOXI
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39532-2105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 228-396-3374
-----------------------------------------------------
Fax | 228-396-3379
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SECRETARY
-----------------------------------------------------
Name | MR. MICHAEL N PHILLIPS
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 228-864-1212
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------