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General NPI Number Information
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NPI Number | 1376651299
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Entity Type | Organization
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Legal Business Name | COASTAL REHABILITATION OF SOUTH MISSISSIPPI
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 15190 COMMUNITY RD SUITE 110
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City | GULFPORT
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State | MS
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Zip | 39503-3485
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Country | US
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Telephone | 228-831-4646
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Fax |
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Provider Business Mailing Address
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Address Line | 15190 COMMUNITY RD SUITE 110
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City | GULFPORT
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State | MS
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Zip | 39503-3485
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Country | US
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Telephone | 228-831-4646
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JOE FRAME
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Credential | PT
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Telephone | 228-831-4646
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State | MS
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