NPIMap

Organization Active NPI

Coastal Rehabilitation Inc

  • Physical Therapist
  • Kitty Hawk, NC
National Provider Identifier
1871610907
Registry record updated Sep 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
COASTAL REHABILITATION INC
Practice address
5585 N Croatan Hwy
Kitty Hawk, NC 27949-3996
Phone
(252) 261-1556
Fax
(252) 261-6161
NPI assigned
Mar 23, 2007
Last updated
Sep 22, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 22, 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 2

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

Addresses

Primary practice location

5585 N Croatan Hwy
Kitty Hawk, NC 27949-3996

Mailing address

101 Medical Drive
Elizabeth City, NC 27809-3361
Phone (252) 338-2114

Other identifiers 4

IdentifierTypeStateIssuer
07763OtherBCBS
7200037MedicaidNC
7700350MedicaidNC
0002WOtherBCBS FACILITY

National Provider Directory

National Provider Directory

Locations

5567 N Croatan Hwy
Kitty Hawk, NC 27949
Phone (252) 261-1556

5585 N Croatan Hwy
Kitty Hawk, NC 27949
Phone (252) 261-1556

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1174608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663804800000",
    "number": "1871610907",
    "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": "278093361",
            "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": "5585 N CROATAN HWY",
            "city": "KITTY HAWK",
            "state": "NC",
            "postal_code": "279493996",
            "telephone_number": "252-261-1556",
            "fax_number": "252-261-6161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL REHABILITATION INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-23",
        "last_updated": "2022-09-22",
        "certification_date": "2022-09-22",
        "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": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "07763",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7200037",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7700350",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS FACILITY",
            "identifier": "0002W",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kitty Hawk, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 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.