| Organization Name: | COASTLINE PHYSICAL MEDICINE AND REHABILITATION INC. |
| NPI Number: | 1518356658 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | VINCENT MESSBARGER (OWNER) |
| Mailing Address: | 4011 Hwy 40 Saint Marys |
| State: | GA US |
| Postal Code: | 315584067 |
| Phone Number: | 9125769507 |
| Fax Number: | 9125769515 |
| NPI Enumeration Date: | 01/13/2015 |
| NPI Last Update Date: | 01/24/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | GA68069 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |