NPIMap

Organization Active NPI

Coastal Rehabilitation Inc

  • Physical Therapist
  • Elizabeth City, NC
National Provider Identifier
1457418311
Registry record updated Sep 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
COASTAL REHABILITATION INC
Practice address
101 Medical Drive
Elizabeth City, NC 27909
Phone
(252) 338-2114
Fax
(252) 338-2115
NPI assigned
Jan 2, 2007
Last updated
Sep 28, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2022

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

Authorized official

Name
Mr. Justyn J Yager, DPTNPI 1124556758
Title
Owner
Phone
(252) 338-2114

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X NU
Physical Therapist 225100000X NC
Physical Therapist 225100000X NU Primary

Addresses

Primary practice location

101 Medical Drive
Elizabeth City, NC 27909

Mailing address

101 Medical Drive
Elizabeth City, NC 27909
Phone (252) 338-2114

Other identifiers 6

IdentifierTypeStateIssuer
7200037MedicaidNC
3120758OtherNCONENET-OT
2120758OtherNCONENET-PT
07763OtherNCBCBS
0002WOtherNCBCBS FACILITY GROUP
7207763MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20030930000031 NC Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 9537071535 Practice locations: Edenton, NC; Elizabeth Cty, NC; Kitty Hawk, NC; Manteo, NC; Moyock, NC; Ahoskie, NC
O20071212000770 NC Part B Supplier - Clinic/Group Practice 9537071535 Receives reassigned benefits from 20 practitioners
Practice locations: Elizabeth City, NC; Moyock, NC; Manteo, NC; Kitty Hawk, NC; Edenton, NC; Ahoskie, NC

National Provider Directory

National Provider Directory
Tax ID family
Coastal Rehab Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

115 Loftin Ln
Ahoskie, NC 27910
Phone (252) 209-0901

701 Luke St
Ste B
Edenton, NC 27932
Phone (252) 482-7339

503 Cypress Ln
#A
Manteo, NC 27954
Phone (252) 338-2114

Practitioners & affiliated clinicians

Practitioners 31

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.

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664323200000",
    "number": "1457418311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 MEDICAL DRIVE",
            "city": "ELIZABETH CITY",
            "state": "NC",
            "postal_code": "27909",
            "telephone_number": "252-338-2114",
            "fax_number": "252-338-2115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 MEDICAL DRIVE",
            "city": "ELIZABETH CITY",
            "state": "NC",
            "postal_code": "27909",
            "telephone_number": "252-338-2114",
            "fax_number": "252-338-2115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL REHABILITATION INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-02",
        "last_updated": "2022-09-28",
        "certification_date": "2022-09-28",
        "status": "A",
        "authorized_official_last_name": "YAGER",
        "authorized_official_first_name": "JUSTYN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "252-338-2114",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7200037",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ONENET-OT",
            "identifier": "3120758",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ONENET-PT",
            "identifier": "2120758",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "07763",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS FACILITY GROUP",
            "identifier": "0002W",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7207763",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elizabeth City, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2022; 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.