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General NPI Number Information
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NPI Number | 1508301474
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Entity Type | Organization
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Legal Business Name | BOZLEE PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 12/30/2016
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Last Update Date | 12/30/2016
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Provider Practice Location Address
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Address Line | 12311 ASHLEY DR STE B
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City | GULFPORT
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State | MS
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Zip | 39503-2950
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Country | US
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Telephone | 228-206-0400
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Fax | 228-206-1851
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Provider Business Mailing Address
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Address Line | 12311 ASHLEY DR STE B
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City | GULFPORT
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State | MS
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Zip | 39503-2950
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Country | US
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Telephone | 228-206-0400
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Fax | 228-206-1851
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Authorized Official
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Title or Position | CO-OWNER/PHYSICAL THERAPIST
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Name | ELIZABETH BOZLEE
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Credential | P.T.
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Telephone | 228-206-0400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT1109
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License Number State | MS
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