Provider Demographics
NPI:1861546061
Name:GCOC PHYSICAL THERAPY
Entity type:Organization
Organization Name:GCOC PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:HANSHEW
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:727-868-9563
Mailing Address - Street 1:PO BOX 5515
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34674-5515
Mailing Address - Country:US
Mailing Address - Phone:727-868-9563
Mailing Address - Fax:727-869-6909
Practice Address - Street 1:7315 HUDSON AVE
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-1158
Practice Address - Country:US
Practice Address - Phone:727-868-9563
Practice Address - Fax:727-869-6909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0038324261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1060673200OtherDEPT OF LABOR
FLQ56OtherBLUE CROSS BLUE SHIELD
FL1060673200OtherDEPT OF LABOR