MEDICARE: GULF COAST NEUROWELLNESS 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	247200000X	Other Technician

General Provider Information

NPI Number	:	1881525590
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GULF COAST NEUROWELLNESS LLC

Provider Business Mailing Address
First Line	:	9808 MILLWOOD CIR STE C
Second Line	:
City	:	SPANISH FORT
State	:	AL
Zip	:	36527-5455
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9808 MILLWOOD CIR
Second Line	:
City	:	SPANISH FORT
State	:	AL
Zip	:	36527-5454
Country	:	US
Telephone Number	:	251-310-3700
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ASHLEY MARKS
Credential	:
Telephone Number	:	251-767-6898

Provider Enumeration Date	:	05/29/2026
Last Update Date	:	05/29/2026

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