Gulf Coast Brain Sport & Spine LLC
Physical Medicine & Rehabilitation in Covington, LA. Organization (NPI-2).
NPI number1699055475
StatusActive
Last updated in NPPESMar 30, 2013
Details
- NPI
- 1699055475
- Entity type
- Organization (NPI-2)
- Legal business name
- Gulf Coast Brain Sport & Spine LLC
- Organization subpart
- No
- Enumeration date
- Aug 24, 2011
- Last updated
- Mar 30, 2013
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208100000X | Physical Medicine & Rehabilitation | 14743R | LA | Yes |
Practice location
1331 Ochsner BlvdSuite 100
Covington, LA 70433-8177
Phone 985-234-0490
Mailing address
Po Box 2013Mandeville, LA 70470-2013
Phone 504-237-1430
Authorized official
Beau J Bagley
Owner
5042371430
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