| Organization Name: | COASTAL PHYSICAL THERAPY LLC |
| NPI Number: | 1043375520 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BRADLEY G KELLY (OWNER, MANAGING MEMBER) |
| Mailing Address: | 580 5th St Suite 600 Brookings |
| State: | OR US |
| Postal Code: | 974158329 |
| Phone Number: | 5414697314 |
| Fax Number: | 5414693669 |
| NPI Enumeration Date: | 12/26/2006 |
| NPI Last Update Date: | 09/30/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 3984 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |