NPIMap

Organization Active NPI

Coastal Rehab and Sports Medicine

  • Physical Therapy Clinic/Center
  • Palm Coast, FL
National Provider Identifier
1982946810
Registry record updated Jun 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
PT21524 Issued in FL
Legal business name
COASTAL REHAB AND SPORTS MEDICINE
Practice address
360 Palm Coast Pkwy NE
Palm Coast, FL 32137-3805
Phone
(386) 446-4101
Fax
(386) 447-2161
NPI assigned
Mar 18, 2013
Last updated
Jun 9, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2022

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

Authorized official

Name
William Joseph Sibille, DPTNPI 1184060899
Title
Owner
Phone
(904) 501-4344

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
Physical Therapy Clinic/Center 261QP2000X PT21524 FL Primary

Addresses

Primary practice location

360 Palm Coast Pkwy NE
Palm Coast, FL 32137-3805

Mailing address

360 Palm Coast Pkwy NE
Palm Coast, FL 32137-3805
Phone (386) 446-4101

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130814000522 FL Part B Supplier - Physical/Occupational Therapy Group in Private Practice 5294977666 Receives reassigned benefits from 10 practitioners
Practice locations: Palm Coast, FL

National Provider Directory

National Provider Directory

Locations

360 Palm Coast Pkwy NE
Palm Coast, FL 32137
Phone (386) 446-4101

360 Palm Coast Pkwy NE
#N
Palm Coast, FL 32137
Phone (386) 446-4101

520 Palm Coast Pkwy SW
Ste 101
Palm Coast, FL 32137
Phone (386) 446-4101

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1363564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654732800000",
    "number": "1982946810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "360 PALM COAST PKWY NE",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321373805",
            "telephone_number": "386-446-4101",
            "fax_number": "386-447-2161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 PALM COAST PKWY NE",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321373805",
            "telephone_number": "386-446-4101",
            "fax_number": "386-447-2161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL REHAB AND SPORTS MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-18",
        "last_updated": "2022-06-09",
        "certification_date": "2022-06-09",
        "status": "A",
        "authorized_official_last_name": "SIBILLE",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-501-4344",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "FL",
            "license": "PT21524",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Palm Coast, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 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.