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NPI Code Detail

MEDICARE: GULF COAST PHYSICAL MEDICINE, INC.

MEDICARE: GULF COAST PHYSICAL MEDICINE, INC.
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
1111N00000XChiropractorCH7203FL

Other Identifiers

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

General Provider Information

NPI Number : 1902081649
Entity Type Code : Organization
Provider Name (Legal Business Name) : GULF COAST PHYSICAL MEDICINE, INC.
Provider Business Mailing Address
First Line : 6250 PARK BLVD
Second Line :
City : PINELLAS PARK
State : FL
Zip : 33781-3237
Country : US
Telephone Number : 727-541-2520
Fax Number : 727-544-8971
Provider Business Practice Location Address
First Line : 6250 PARK BLVD
Second Line :
City : PINELLAS PARK
State : FL
Zip : 33781-3237
Country : US
Telephone Number : 727-541-2520
Fax Number : 727-544-8971
Authorized Official
Title or Position : PRESIDENT
Name : DR. KEVIN R LEE
Credential : D.C.
Telephone Number : 727-541-2520
Provider Enumeration Date : 12/31/2007
Last Update Date : 12/31/2007

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Directions to “GULF COAST PHYSICAL MEDICINE, INC. ” Practice Location

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