Coastal PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

COASTAL PT

Practice address

424 College Blvd
Valparaiso, FL 32580-1774

Phone

(850) 378-2600

Fax

(833) 869-6437

NPI assigned

Oct 14, 2021

Organization subpart

No

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

Authorized official

Name

Traci Duncan Green, M.P.T.

Title

Owner/PT

Phone

(850) 378-2600

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Jennifer Leigh Gaddy, DPT

  • Physical Therapist
  • Valparaiso, FL
  • NPI 1912064098
  NPD

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

{
    "created_epoch": "1634169600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634169600000",
    "number": "1679236806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6021 STERLING RIVER WAY",
            "city": "NICEVILLE",
            "state": "FL",
            "postal_code": "325781534",
            "telephone_number": "850-378-2600",
            "fax_number": "833-869-6437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "424 COLLEGE BLVD",
            "city": "VALPARAISO",
            "state": "FL",
            "postal_code": "325801774",
            "telephone_number": "850-378-2600",
            "fax_number": "833-869-6437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL PT",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-14",
        "last_updated": "2021-10-14",
        "certification_date": "2021-10-14",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "TRACI",
        "authorized_official_middle_name": "DUNCAN",
        "authorized_official_title_or_position": "OWNER/PT",
        "authorized_official_telephone_number": "850-378-2600",
        "authorized_official_credential": "M.P.T."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Valparaiso, FL
• Providers in Valparaiso, FL by specialty
• Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2021; 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.