Provider Demographics
NPI:1447882287
Name:PHYSICAL THERAPY CENTER OF OCEAN SPRINGS, LLC
Entity type:Organization
Organization Name:PHYSICAL THERAPY CENTER OF OCEAN SPRINGS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:G
Authorized Official - Last Name:ROLL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:228-863-7267
Mailing Address - Street 1:PO BOX 834
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39566-0834
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6059 U S HIGHWAY 98 STE 50
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-9456
Practice Address - Country:US
Practice Address - Phone:769-235-2884
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty