Healthcare Provider Details

I. General information

NPI: 1447277405
Provider Name (Legal Business Name): COASTAL PHYSICAL MEDICINE & REHABILITATION SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 06/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 NEUSE BLVD
NEW BERN NC
28560-3449
US

IV. Provider business mailing address

2000 NEUSE BLVD
NEW BERN NC
28560-3449
US

V. Phone/Fax

Practice location:
  • Phone: 252-633-8024
  • Fax: 252-633-8994
Mailing address:
  • Phone: 252-633-8024
  • Fax: 252-633-8994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNC

VIII. Authorized Official

Name: MRS. KATHERINE MACK
Title or Position: PRACTICE ADMIN
Credential:
Phone: 252-633-8024