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General NPI Number Information
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NPI Number | 1841215670
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Entity Type | Organization
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Legal Business Name | PHYSICAL THERAPY CLINIC OF GULFPORT
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 07/02/2008
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Provider Practice Location Address
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Address Line | 3506 WASHINGTON AVE STE. D
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City | GULFPORT
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State | MS
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Zip | 39507-3103
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Country | US
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Telephone | 228-863-0200
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Fax | 228-863-0809
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Provider Business Mailing Address
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Address Line | 3506 WASHINGTON AVE STE. D
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City | GULFPORT
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State | MS
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Zip | 39507-3103
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Country | US
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Telephone | 228-863-0200
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Fax | 228-863-0809
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Authorized Official
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Title or Position | PHYSICAL THERAPIST, OWNER
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Name | MR. STEVEN W HOLLAND
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Credential | P.T.
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Telephone | 228-863-0200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PT1574
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License Number State | MS
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