Healthcare Provider Details

I. General information

NPI: 1932327830
Provider Name (Legal Business Name): COASTAL PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5725 RALSTON ST STE 103
VENTURA CA
93003-6053
US

IV. Provider business mailing address

5725 RALSTON STREET SUITE 103
VENTURA CA
93003
US

V. Phone/Fax

Practice location:
  • Phone: 805-658-6964
  • Fax: 805-477-0370
Mailing address:
  • Phone: 805-658-6964
  • Fax: 805-477-0370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. KIRK P.M. RICHARDS
Title or Position: PRESIDENT
Credential: PT
Phone: 805-658-6964