# GULF COAST SPINAL & NEUROSURGICAL SPECIALISTS LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** GULF COAST SPINAL & NEUROSURGICAL SPECIALISTS LLC
- **Other names:** PHYSICAL THERAPY DEPARTMENT
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1912270869
- **Legal business name:** GULF COAST SPINAL & NEUROSURGICAL SPECIALISTS LLC
- **Authorized official:** MS. MELANIE L FAYARD PT (CLINIC MANAGER)
- **Authorized official phone:** (228) 875-4000

## Contact information

- **Practice address:** 11010 DAVID ST, SUITE B, GULFPORT, MS 39503-3481
- **Practice address phone:** (228) 832-8327
- **Practice address fax:** (228) 832-8328
- **Mailing address:** 11010 DAVID ST, SUITE B, GULFPORT, MS 39503-3481
- **Mailing address phone:** (228) 832-8327
- **Mailing address fax:** (228) 832-8328

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | Yes |
| 225100000X | Physical Therapist | — | — | Yes |

## Other

- **Enumeration date:** 02/22/2012
- **Last updated:** 02/22/2012