NPIMap

Organization Active NPI

Coastal Wellness and Physical Therapy, Inc

Doing business as Christine Ely Physical Therapy

  • Sports Medicine (Physical Medicine & Rehabilitation) Physician
  • Half Moon Bay, CA
National Provider Identifier
1972251023
Registry record updated Mar 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081S0010X
Legal business name
COASTAL WELLNESS AND PHYSICAL THERAPY, INC
Doing business as
Christine Ely Physical Therapy
Practice address
785 Main St Ste a
Half Moon Bay, CA 94019-1987
Phone
(650) 712-8400
NPI assigned
Mar 16, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2022

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

Authorized official

Name
Kanchan Physical Khurana, PT, MPTNPI 1871916916
Title
President
Phone
(310) 424-0425

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Physical Medicine & Rehabilitation) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2081S0010X Primary

Addresses

Primary practice location

785 Main St Ste a
Half Moon Bay, CA 94019-1987

Mailing address

785 Main St Ste a
Half Moon Bay, CA 94019-1987
Phone (310) 424-0425

Other names 1

  • Christine Ely Physical Therapy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220606000887 CA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 6507244480 Receives reassigned benefits from 2 practitioners
Practice locations: Half Moon Bay, CA

National Provider Directory

National Provider Directory

Locations

785 Main St
Ste A
Half Moon Bay, CA 94019
Phone (650) 712-8400

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1647388800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647388800000",
    "number": "1972251023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "785 MAIN ST STE A",
            "city": "HALF MOON BAY",
            "state": "CA",
            "postal_code": "940191987",
            "telephone_number": "310-424-0425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "785 MAIN ST STE A",
            "city": "HALF MOON BAY",
            "state": "CA",
            "postal_code": "940191987",
            "telephone_number": "650-712-8400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL WELLNESS AND PHYSICAL THERAPY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-16",
        "last_updated": "2022-03-16",
        "certification_date": "2022-03-16",
        "status": "A",
        "authorized_official_last_name": "KHURANA",
        "authorized_official_first_name": "KANCHAN",
        "authorized_official_middle_name": "PHYSICAL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-424-0425",
        "authorized_official_credential": "PT, MPT"
    },
    "taxonomies": [
        {
            "code": "2081S0010X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Christine Ely Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Half Moon Bay, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 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.