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General NPI Number Information
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NPI Number | 1043172893
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Entity Type | Organization
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Legal Business Name | COASTAL MEDICAL MASSAGE INSTITUTE LLC
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Dates
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Enumeration Date | 12/01/2025
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 5599 STEWART ST
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City | MILTON
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State | FL
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Zip | 32570-4344
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Country | US
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Telephone | 850-530-8082
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Fax | 448-216-2818
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Provider Business Mailing Address
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Address Line | 3702 ROCKWOOD DR
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City | PACE
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State | FL
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Zip | 32571-1867
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Country | US
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Telephone | 850-530-8082
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Fax | 448-216-2818
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | PAUL J PHELPS
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Credential |
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Telephone | 850-530-8082
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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