| Organization Name: | COASTAL PHYSICAL THERAPY LLC |
| NPI Number: | 1275768194 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | VANESSA RACHEL MARTIN (PRESIDENT) |
| Mailing Address: | 18990 Persimmon Ridge Rd Alva |
| State: | FL US |
| Postal Code: | 339203367 |
| Phone Number: | 9416810278 |
| Fax Number: | 2392360217 |
| NPI Enumeration Date: | 05/20/2009 |
| NPI Last Update Date: | 09/16/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | PT23483 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |