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General NPI Number Information
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NPI Number | 1104223791
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Entity Type | Organization
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Legal Business Name | COAST TO COAST COMPREHENSIVE REHAB SERVICES, INC
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Dates
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Enumeration Date | 11/25/2014
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Last Update Date | 11/25/2014
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Provider Practice Location Address
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Address Line | 14750 SW 26TH ST SUITE#114
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City | MIAMI
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State | FL
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Zip | 33185-5933
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Country | US
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Telephone | 305-456-0901
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Fax | 305-456-0906
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Provider Business Mailing Address
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Address Line | 14750 SW 26TH ST SUITE#114
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City | MIAMI
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State | FL
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Zip | 33185-5933
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Country | US
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Telephone | 305-456-0901
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Fax | 305-456-0906
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. LUIS F ROA
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Credential | PT
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Telephone | 305-456-0901
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT22682
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License Number State | FL
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