MEDICARE: PHYSICAL THERAPY CENTER OF OCEAN SPRINGS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578647780
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICAL THERAPY CENTER OF OCEAN SPRINGS, LLC

Provider Business Mailing Address
First Line	:	PO BOX 96219
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85072-6219
Country	:	US
Telephone Number	:	228-872-6821
Fax Number	:	228-872-6891

Provider Business Practice Location Address
First Line	:	900 HOLCOMB BLVD STE A
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564
Country	:	US
Telephone Number	:	228-872-6821
Fax Number	:	228-872-6891

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	ANNA GAYLORD
Credential	:
Telephone Number	:	678-837-7176

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	01/07/2026

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