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General NPI Number Information
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NPI Number | 1699001685
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Entity Type | Organization
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Legal Business Name | COASTAL PHYSICAL THERAPY INC
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Dates
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Enumeration Date | 10/26/2009
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Last Update Date | 10/26/2009
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Provider Practice Location Address
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Address Line | 5725 RALSTON ST #103
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City | VENTURA
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State | CA
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Zip | 93003-6053
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Country | US
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Telephone | 805-658-6964
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Fax | 805-477-0370
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Provider Business Mailing Address
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Address Line | 5725 RALSTON ST #103
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City | VENTURA
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State | CA
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Zip | 93003-6053
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Country | US
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Telephone | 805-658-6964
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Fax | 805-477-0370
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Authorized Official
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Title or Position | PRESIDENT
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Name | KIRK RICHARDS
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Credential | P.T.
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Telephone | 805-658-6964
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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 | PT25537
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT26197
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License Number State | CA
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