Provider Demographics
NPI:1023227436
Name:GULF COAST THERAPY ASSOCIATES, P.A.
Entity type:Organization
Organization Name:GULF COAST THERAPY ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:THEESA
Authorized Official - Middle Name:C
Authorized Official - Last Name:BENOCK
Authorized Official - Suffix:
Authorized Official - Credentials:OTRCHT
Authorized Official - Phone:941-624-6222
Mailing Address - Street 1:12576 BACCHUS RD
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33981-1509
Mailing Address - Country:US
Mailing Address - Phone:941-698-1191
Mailing Address - Fax:
Practice Address - Street 1:3417 TAMIAMI TRL STE A
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-8158
Practice Address - Country:US
Practice Address - Phone:941-624-6222
Practice Address - Fax:941-624-6831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT1055332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLR6FOtherBCBS
FL=========OtherTAX ID
FL106878Medicare ID - Type Unspecified
FL=========OtherTAX ID