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General NPI Number Information
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NPI Number | 1053580662
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Entity Type | Organization
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Legal Business Name | COASTAL PHYSICAL MEDICINE, PA
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Dates
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Enumeration Date | 02/27/2008
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Last Update Date | 02/27/2008
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Provider Practice Location Address
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Address Line | 3185 AZALEA DR
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City | NORTH CHARLESTON
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State | SC
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Zip | 29405-8211
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Country | US
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Telephone | 843-762-2274
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Fax | 843-762-2278
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Provider Business Mailing Address
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Address Line | PO BOX 12819
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City | CHARLESTON
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State | SC
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Zip | 29422-2819
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Country | US
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Telephone | 843-762-2274
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Fax | 843-762-2278
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | REBECCA MCSWAIN
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Credential |
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Telephone | 843-762-2274
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 19612
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License Number State | SC
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