NPIMap

Organization Active NPI

Coast Physical Therapy, Inc

  • Physical Therapist
  • Titusville, FL
National Provider Identifier
1053483685
Registry record updated Feb 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
COAST PHYSICAL THERAPY, INC
Practice address
500 N. Washington Ave
Ste 107
Titusville, FL 32796
Phone
(321) 269-0800
Fax
(321) 383-0404
NPI assigned
Nov 15, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Michael Alan Johnson, DPT, ATCNPI 1902320856
Title
Owner/Physical Therapist
Phone
(321) 607-2454

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X FL Primary

Addresses

Primary practice location

500 N. Washington Ave
Ste 107
Titusville, FL 32796

Mailing address

500 N. Washington Ave
Ste 107
Titusville, FL 32796
Phone (321) 269-0800

Other identifiers 1

IdentifierTypeStateIssuer
886365200MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110801000289 FL Part B Supplier - Physical/Occupational Therapy Group in Private Practice 5698944080 Receives reassigned benefits from 2 practitioners
Practice locations: Titusville, FL

National Provider Directory

National Provider Directory

Locations

500 N Washington Ave
Ste 107
Titusville, FL 32796
Phone (321) 269-0800

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708560000000",
    "number": "1053483685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 N. WASHINGTON AVE",
            "address_2": "STE 107",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "32796",
            "telephone_number": "321-269-0800",
            "fax_number": "321-383-0404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 N. WASHINGTON AVE",
            "address_2": "STE 107",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "32796",
            "telephone_number": "321-269-0800",
            "fax_number": "321-383-0404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COAST PHYSICAL THERAPY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-15",
        "last_updated": "2024-02-22",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "OWNER/PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "321-607-2454",
        "authorized_official_credential": "DPT, ATC"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "886365200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Titusville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.