Coastline Imaging LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

COASTLINE IMAGING LLC

Practice address

1341 Medical Park Dr
Ste. 202
Melbourne, FL 32901-3235

Phone

(321) 253-2700

NPI assigned

Dec 24, 2009

Organization subpart

No

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

Authorized official

Name

Danette Michelle Lauricia

Title

Credentialing Manager

Phone

(321) 253-2700

Specialties & licenses 3

Addresses

Other names 1

• Coastline Physical Therapy Doing business as

Locations

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

{
    "created_epoch": "1261612800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665446400000",
    "number": "1679802599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1341 MEDICAL PARK DR",
            "address_2": "STE. 202",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329013235",
            "telephone_number": "321-253-2700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1341 MEDICAL PARK DR",
            "address_2": "STE. 202",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329013235",
            "telephone_number": "321-253-2700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTLINE IMAGING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-24",
        "last_updated": "2022-10-11",
        "certification_date": "2022-04-24",
        "status": "A",
        "authorized_official_last_name": "LAURICIA",
        "authorized_official_first_name": "DANETTE",
        "authorized_official_middle_name": "MICHELLE",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "321-253-2700"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapy Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coastline Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Coastline Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Coastal Psychiatric Center, Inc.
• Coastal Psychiatric Walk-in Corp
• Coastal Wellness and Life Coaching Center LLC
• Coastline Family Chiropractic Melbourne LLC
• Coastline Imaging LLC
• Coastline Imaging LLC
• Melinda Ann Cobb, PA
• Christian M Cobbold, MD
• Lisa Frier Cobbs, MSN, ARNP, FNP-C
• Victoria Cobham

• Physical Therapist in Melbourne, FL
• Providers in Melbourne, 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 11, 2022; 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.