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General NPI Number Information
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NPI Number | 1366251597
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Entity Type | Organization
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Legal Business Name | COASTAL PHYSICAL THERAPY & BALANCE CENTER INC
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Dates
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Enumeration Date | 01/02/2025
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Last Update Date | 01/02/2025
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Provider Practice Location Address
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Address Line | 576 METACOM AVE STE 9&10
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City | BRISTOL
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State | RI
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Zip | 02809-5100
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Country | US
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Telephone | 401-253-1353
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Fax | 401-253-8320
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Provider Business Mailing Address
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Address Line | 576 METACOM AVE STE 9&10
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City | BRISTOL
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State | RI
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Zip | 02809-5100
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Country | US
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Telephone | 401-253-1353
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Fax | 401-253-8320
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | DR. DANIELLE K MAKUCEVICH
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Credential | PT, DPT
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Telephone | 401-714-5023
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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 |
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License Number State |
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