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General NPI Number Information
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NPI Number | 1174380422
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Entity Type | Organization
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Legal Business Name | COASTLINE PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 03/04/2024
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Last Update Date | 03/04/2024
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Provider Practice Location Address
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Address Line | 3781 S NOVA RD STE B
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City | PORT ORANGE
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State | FL
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Zip | 32129-4285
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Country | US
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Telephone | 770-235-0071
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Fax |
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Provider Business Mailing Address
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Address Line | 704 HORTON ST
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32169-2920
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Country | US
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Telephone | 770-235-0071
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JOHN MINELLA
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Credential |
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Telephone | 770-235-0071
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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 |
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