=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780293837
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COASTAL MOVEMENT SPECIALISTS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2020
-----------------------------------------------------
Last Update Date | 09/30/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2052 RIVER RD STE E
-----------------------------------------------------
City | JOHNS ISLAND
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29455-8805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-900-6202
-----------------------------------------------------
Fax | 843-574-8858
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2052 RIVER RD STE E
-----------------------------------------------------
City | JOHNS ISLAND
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29455-9043
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-900-6202
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER/PT
-----------------------------------------------------
Name | KRISTEN THOMAS
-----------------------------------------------------
Credential | PT, DPT
-----------------------------------------------------
Telephone | 317-752-4580
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------