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General NPI Number Information
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NPI Number | 1073739561
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Entity Type | Organization
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Legal Business Name | COASTAL REHABILITATION INC
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 501 MAIN STREET
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City | GATESVILLE
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State | NC
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Zip | 27938
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Country | US
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Telephone | 252-357-1011
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Fax | 252-357-0048
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Provider Business Mailing Address
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Address Line | 101 MEDICAL DRIVE
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City | ELIZABETH CITY
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State | NC
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Zip | 27969-3361
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Country | US
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Telephone | 252-338-2114
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Fax | 252-338-2115
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Authorized Official
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Title or Position | OWNER
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Name | MR. SHERMAN B BLYSTONE JR.
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Credential | PT
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Telephone | 252-338-2114
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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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 |
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