MEDICARE: GULF COAST REHABILITATION, PC

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	261QP2000X	Physical Therapy Clinic/Center	PT3521	MS

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	:	1730388554
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GULF COAST REHABILITATION, PC

Provider Business Mailing Address
First Line	:	PO BOX 605
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39566-0605
Country	:	US
Telephone Number	:	228-818-9164
Fax Number	:	228-818-9167

Provider Business Practice Location Address
First Line	:	1706 BIENVILLE BLVD
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-3073
Country	:	US
Telephone Number	:	228-818-9164
Fax Number	:	228-818-9167

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MISS JOCELYN ALLEEN MAYFIELD
Credential	:	MPT, OTR/L
Telephone Number	:	228-818-9164

Provider Enumeration Date	:	07/12/2007
Last Update Date	:	07/12/2007

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