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General NPI Number Information
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NPI Number | 1619978012
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Entity Type | Organization
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Legal Business Name | COASTAL ORTHOPAEDIC DESIGNS
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Dates
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Enumeration Date | 08/09/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 12551 INDIAN ROCKS RD STE 12
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City | LARGO
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State | FL
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Zip | 33774-3038
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Country | US
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Telephone | 272-596-5750
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Fax | 727-596-8952
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Provider Business Mailing Address
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Address Line | 12551 INDIAN ROCKS RD STE 12
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City | LARGO
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State | FL
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Zip | 33774-3038
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Country | US
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Telephone | 272-596-5750
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Fax | 727-596-8952
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MR. BRIAN BERNARD LANGLAIS
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Credential |
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Telephone | 727-596-5750
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | ORT41
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License Number State | FL
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