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General NPI Number Information
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NPI Number | 1053483685
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Entity Type | Organization
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Legal Business Name | COAST PHYSICAL THERAPY, INC
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 02/22/2024
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Provider Practice Location Address
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Address Line | 500 N. WASHINGTON AVE STE 107
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City | TITUSVILLE
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State | FL
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Zip | 32796
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Country | US
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Telephone | 321-269-0800
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Fax | 321-383-0404
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Provider Business Mailing Address
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Address Line | 500 N. WASHINGTON AVE STE 107
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City | TITUSVILLE
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State | FL
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Zip | 32796
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Country | US
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Telephone | 321-269-0800
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Fax | 321-383-0404
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | MICHAEL ALAN JOHNSON
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Credential | DPT, ATC
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Telephone | 321-607-2454
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State | FL
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