Intracoastal Physical Therapy, LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

INTRACOASTAL PHYSICAL THERAPY, LLC

Practice address

308 S Harbor City Blvd
Suite B
Melbourne, FL 32901-1500

Phone

(321) 951-2416

Fax

(321) 951-2077

NPI assigned

Nov 11, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Matthew Karl Thompson, RPT

Title

Owner

Phone

(321) 951-2416

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

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

• Kenneth Michael Jagdmann, RPT

  • Physical Therapist
  • Melbourne, FL
  • NPI 1619959632
  NPD (past)

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

{
    "created_epoch": "1131667200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1962483370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "308 S HARBOR CITY BLVD",
            "address_2": "SUITE B",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329011500",
            "telephone_number": "321-951-2416",
            "fax_number": "321-951-2077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "308 S HARBOR CITY BLVD",
            "address_2": "SUITE B",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329011500",
            "telephone_number": "321-951-2416",
            "fax_number": "321-951-2077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTRACOASTAL PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "THOMPSON",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "KARL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "321-951-2416",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD GR",
            "identifier": "Y902W",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• 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 Aug 22, 2020; 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.