Organization Name: | COASTAL CAROLINA PHYSICAL REHAB INC |
NPI Number: | 1932344454 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MAYRA ALFONSO (OWNER) |
Mailing Address: | 235 Singleton Ridge Rd Suite 108 Conway |
State: | SC US |
Postal Code: | 29526 |
Phone Number: | 8433474175 |
Fax Number: | 8433474179 |
NPI Enumeration Date: | 12/12/2008 |
NPI Last Update Date: | 12/12/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | MD21577 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | SC |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |