MEDICARE: COASTLINE PHYSICAL MEDICINE AND REHABILITATION INC.

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	208D00000X	General Practice Physician	GA68069	GA

General Provider Information

NPI Number	:	1518356658
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COASTLINE PHYSICAL MEDICINE AND REHABILITATION INC.

Provider Business Mailing Address
First Line	:	4011 HWY 40
Second Line	:
City	:	SAINT MARYS
State	:	GA
Zip	:	31558-4067
Country	:	US
Telephone Number	:	912-576-9507
Fax Number	:	912-576-9515

Provider Business Practice Location Address
First Line	:	4011 HWY 40
Second Line	:
City	:	SAINT MARYS
State	:	GA
Zip	:	31558-4067
Country	:	US
Telephone Number	:	912-576-9507
Fax Number	:	912-576-9515

Authorized Official
Title or Position	:	OWNER
Name	:	DR. VINCENT MESSBARGER
Credential	:	M.D.
Telephone Number	:	912-576-9507

Provider Enumeration Date	:	01/13/2015
Last Update Date	:	01/24/2015

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