NPIMap

Organization Active NPI

Coastline Physical Therapy & Performance Inc

  • Orthopedic Physical Therapist
  • Deer Isle, ME
National Provider Identifier
1104358365
Registry record updated Jan 31, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic Physical TherapistTaxonomy code 2251X0800X
License
PT4816 Issued in ME
Legal business name
COASTLINE PHYSICAL THERAPY & PERFORMANCE INC
Practice address
5 Main Street
Deer Isle, ME 04627
Phone
(207) 348-3334
Fax
(866) 454-2555
NPI assigned
Mar 28, 2017
Last updated
Jan 31, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2025

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

Authorized official

Name
Dr. Hollan Oliver, DPT, OCS, SCSNPI 1366750317
Title
Owner
Phone
(207) 348-3334

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
Orthopedic Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 2251X0800X PT4816 ME Primary

Addresses

Primary practice location

5 Main Street
Deer Isle, ME 04627

Mailing address

PO Box 264
Deer Isle, ME 04627
Phone (207) 348-3334

Other practice location 1

1 West Ln Ste B
Blue Hill, ME 04614-6102
Phone (207) 374-7246

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250127000492 ME Part B Supplier - Physical/Occupational Therapy Group in Private Practice 4880123421 Receives reassigned benefits from 6 practitioners
Practice locations: Blue Hill, ME; Deer Isle, ME

National Provider Directory

National Provider Directory

Locations

1 West Ln
Ste B
Blue Hill, ME 04614
Phone (207) 374-7246

5 Main St
Deer Isle, ME 04627
Phone (207) 348-3334

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1490659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738281600000",
    "number": "1104358365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 264",
            "city": "DEER ISLE",
            "state": "ME",
            "postal_code": "04627",
            "telephone_number": "207-348-3334",
            "fax_number": "866-454-2555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 MAIN STREET",
            "city": "DEER ISLE",
            "state": "ME",
            "postal_code": "04627",
            "telephone_number": "207-348-3334",
            "fax_number": "866-454-2555"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 West Ln Ste B",
            "address_purpose": "LOCATION",
            "city": "Blue Hill",
            "state": "ME",
            "postal_code": "046146102",
            "country_code": "US",
            "telephone_number": "207-374-7246",
            "fax_number": "866-454-2555",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "COASTLINE PHYSICAL THERAPY & PERFORMANCE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-28",
        "last_updated": "2025-01-31",
        "certification_date": "2025-01-30",
        "status": "A",
        "authorized_official_last_name": "OLIVER",
        "authorized_official_first_name": "HOLLAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "207-348-3334",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPT, OCS, SCS"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist, Orthopedic",
            "state": "ME",
            "license": "PT4816",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Deer Isle, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2025; 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.