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General NPI Number Information
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NPI Number | 1699937839
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Entity Type | Organization
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Legal Business Name | COASTAL PHYSICAL THERAPY & SPORTS MEDICINE LLC
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Dates
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Enumeration Date | 06/30/2008
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Last Update Date | 01/20/2021
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Provider Practice Location Address
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Address Line | 1502 PEMBERTON DR STE C
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City | SALISBURY
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State | MD
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Zip | 21801-2475
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Country | US
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Telephone | 410-749-5050
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Fax | 410-749-5057
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Provider Business Mailing Address
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Address Line | 1502 PEMBERTON DR STE C
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City | SALISBURY
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State | MD
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Zip | 21801-2475
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Country | US
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Telephone | 410-749-5050
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Fax | 410-749-5057
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Authorized Official
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Title or Position | OWNER/CLINICAL DIRECTOR
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Name | DR. WILLIAM JEREMY BAILS
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Credential | MSPT, DPT
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Telephone | 410-749-5050
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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 | 20434
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License Number State | MD
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