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General NPI Number Information
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NPI Number | 1730559071
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Entity Type | Organization
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Legal Business Name | COASTAL HOME THERAPY LLC
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Dates
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Enumeration Date | 09/29/2015
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Last Update Date | 09/29/2015
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Provider Practice Location Address
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Address Line | 1509 DEER PARK LN
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City | SURFSIDE BEACH
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State | SC
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Zip | 29575-5245
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Country | US
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Telephone | 843-455-9162
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Fax | 843-595-4686
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Provider Business Mailing Address
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Address Line | 1509 DEER PARK LN
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City | SURFSIDE BEACH
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State | SC
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Zip | 29575-5245
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Country | US
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Telephone | 843-455-9162
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Fax | 843-595-4686
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Authorized Official
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Title or Position | PHYSICAL THERAPIST/ OWNER
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Name | TRAVIS SCOTT BROWN
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Credential | PT
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Telephone | 843-455-9162
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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 | 6522
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License Number State | SC
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