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General NPI Number Information
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NPI Number | 1295169258
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Entity Type | Organization
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Legal Business Name | COASTAL PHYSICAL THERAPY ASSOCIATES
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Dates
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Enumeration Date | 08/27/2013
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Last Update Date | 10/18/2013
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Provider Practice Location Address
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Address Line | 906 S FEDERAL HWY STE B
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City | BOYNTON BEACH
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State | FL
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Zip | 33435-5671
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Country | US
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Telephone | 561-738-0805
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Fax | 561-738-0815
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Provider Business Mailing Address
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Address Line | 906 S FEDERAL HWY STE B
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City | BOYNTON BEACH
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State | FL
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Zip | 33435-5671
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Country | US
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Telephone | 561-738-0805
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Fax | 561-738-0815
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Authorized Official
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Title or Position | OWNER/MANAGER/PRESIDENT
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Name | ANDREW ALAN DIETZ
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Credential | DPT
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Telephone | 267-374-9785
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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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