Gulf Coast Physical Therapy Centers PA

Key facts

NPI

1497837488

Entity type

Organization (NPI type 2)

Primary specialty

Physical Therapist 225100000X

Legal business name

GULF COAST PHYSICAL THERAPY CENTERS PA

Practice address

9471 Three Rivers Rd
Unit D
Gulfport, MS 39503-4230

Phone

(228) 822-9066

Fax

(228) 822-9722

NPI assigned

Oct 19, 2006

Organization subpart

No

Authorized official

Name

Mr. Kenneth J Ackerman, PT

Title

President

Phone

(228) 822-9066

National Provider Directory

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 30, 2015.

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1446163200000",
    "number": "1497837488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3238",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395053238",
            "telephone_number": "228-822-9066",
            "fax_number": "228-822-9722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9471 THREE RIVERS RD",
            "address_2": "UNIT D",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395034230",
            "telephone_number": "228-822-9066",
            "fax_number": "228-822-9722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GULF COAST PHYSICAL THERAPY CENTERS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-19",
        "last_updated": "2015-10-30",
        "status": "A",
        "authorized_official_last_name": "ACKERMAN",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "228-822-9066",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09015748",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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