Basic Information
| Provider Information | |||||||||
| NPI: | 1700844578 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COASTAL PHYSICAL THERAPY INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18 PROFESSIONAL VILLAGE CIRCLE | ||||||||
| Address2: | |||||||||
| City: | BEAUFORT | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8439869670 | ||||||||
| FaxNumber: | 8439869369 | ||||||||
| Practice Location | |||||||||
| Address1: | 18 PROFESSIONAL VILLAGE CIRCLE | ||||||||
| Address2: | |||||||||
| City: | BEAUFORT | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8439869670 | ||||||||
| FaxNumber: | 8439869369 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2006 | ||||||||
| LastUpdateDate: | 09/22/2011 | ||||||||
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| AuthorizedOfficialLastName: | HETHERINGTON | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8439869670 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | PT OCS FAAOMPT CFMT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | SC2123 | SC | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.