| Organization Name: | COAST TO COAST PHYSICAL THERAPY, LLC |
| NPI Number: | 1568835841 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARK JAMES BOLTON (MEMBER) |
| Mailing Address: | 324 Main Street Suite 5 & 6 Owenton |
| State: | KY US |
| Postal Code: | 40359 |
| Phone Number: | 5025142669 |
| Fax Number: | |
| NPI Enumeration Date: | 11/09/2015 |
| NPI Last Update Date: | 11/09/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |