Healthcare Provider Details

I. General information

NPI: 1093749319
Provider Name (Legal Business Name): COASTAL REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6751 MADDOX BLVD
CHINCOTEAGUE VA
23336-2253
US

IV. Provider business mailing address

6751 MADDOX BLVD
CHINCOTEAGUE VA
23336-2253
US

V. Phone/Fax

Practice location:
  • Phone: 757-336-5134
  • Fax:
Mailing address:
  • Phone: 757-336-5134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LOUANN MADDOX KING
Title or Position: PHYSICAL THERAPIST
Credential:
Phone: 757-336-5134