Healthcare Provider Details

I. General information

NPI: 1205338944
Provider Name (Legal Business Name): COASTAL PEDIATRIC THERAPIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2018
Last Update Date: 11/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 W MONTGOMERY XRD STE 102
SAVANNAH GA
31406-4321
US

IV. Provider business mailing address

413 W MONTGOMERY XRD STE 102
SAVANNAH GA
31406-4321
US

V. Phone/Fax

Practice location:
  • Phone: 912-354-4474
  • Fax: 912-354-4443
Mailing address:
  • Phone: 912-354-4474
  • Fax: 912-354-4443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P0010X
TaxonomyPediatric Rehabilitation Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANNA F SALTER
Title or Position: CO-OWNER
Credential: CCC-SLP
Phone: 912-354-4474