Coastal Physical Therapy LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

PT23483 Issued in FL

Legal business name

COASTAL PHYSICAL THERAPY LLC

Practice address

18990 Persimmon Ridge Rd
Alva, FL 33920-3367

Phone

(941) 681-0278

Fax

(239) 236-0217

NPI assigned

May 20, 2009

Last updated

Sep 16, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Vanessa Rachel Martin, MSPT

Title

President

Phone

(941) 681-0278

Specialties & licenses 1

Addresses

Other identifiers 3

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

{
    "created_epoch": "1242777600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1284595200000",
    "number": "1275768194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 62095",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339062095",
            "telephone_number": "941-681-0278",
            "fax_number": "239-236-0217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18990 PERSIMMON RIDGE RD",
            "city": "ALVA",
            "state": "FL",
            "postal_code": "339203367",
            "telephone_number": "941-681-0278",
            "fax_number": "239-236-0217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-20",
        "last_updated": "2010-09-16",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "VANESSA",
        "authorized_official_middle_name": "RACHEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "19416810278",
        "authorized_official_credential": "MSPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "FL",
            "license": "PT23483",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CCN",
            "identifier": "920922584420-002",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "CM700A",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE NUMBER",
            "identifier": "AN9692Z",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christal Bolden
• Melynda J Bosch, MSW, LCSW
• Rita Lauren Chase, CD, CPD, CLC
• Christmas Community Residential Home
• Willie Christmas
• Morgan Rose Colagiovanni, PA-C
• Francheska Noemi Colon Carrasquillo, CCC-SLP
• Janet Farrell Dove, LMFT
• Ginger Enderby
• Kristen Fitts

• Physical Therapy Clinic/Center in Alva, FL
• Providers in Alva, FL by specialty
• Physical Therapy Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.