Healthcare Provider Details

I. General information

NPI: 1376117044
Provider Name (Legal Business Name): COLE COASTAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2021
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 LIBERTY HILL RD
LUMBERTON NC
28358-2442
US

IV. Provider business mailing address

16835 DEER CREEK DR STE 220
SPRING TX
77379-4895
US

V. Phone/Fax

Practice location:
  • Phone: 910-272-9056
  • Fax:
Mailing address:
  • Phone: 832-423-6730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: ADAM COLE
Title or Position: CEO
Credential:
Phone: 832-423-6730