MEDICARE: COASTAL PROSTHETICS AND ORTHOTICS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1437605003
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COASTAL PROSTHETICS AND ORTHOTICS, LLC

Provider Business Mailing Address
First Line	:	433 NETWORK STA
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23320-3851
Country	:	US
Telephone Number	:	757-892-5300
Fax Number	:

Provider Business Practice Location Address
First Line	:	1924 LANDSTOWN CENTRE WAY STE 109
Second Line	:	BOX # 13 FOR MAIL
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-1624
Country	:	US
Telephone Number	:	757-892-5300
Fax Number	:	757-892-5303

Authorized Official
Title or Position	:	ADMINISTRATIVE EXECUTIVE
Name	:	BRITTANY SIVERD
Credential	:
Telephone Number	:	757-892-5300

Provider Enumeration Date	:	09/01/2016
Last Update Date	:	05/14/2024

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