MEDICARE: COASTAL WELLNESS AND PHYSIOTHERAPY, 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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1902530264
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COASTAL WELLNESS AND PHYSIOTHERAPY, LLC

Provider Business Mailing Address
First Line	:	1128 S 7TH ST
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-9319
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1124 S 7TH ST
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-9319
Country	:	US
Telephone Number	:	772-359-4750
Fax Number	:

Authorized Official
Title or Position	:	OWNER, PHYSICAL THERAPIST
Name	:	LEAH SWEAT
Credential	:	DPT
Telephone Number	:	772-359-4750

Provider Enumeration Date	:	07/13/2022
Last Update Date	:	07/13/2022

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