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General NPI Number Information
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NPI Number | 1790593374
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Entity Type | Organization
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Legal Business Name | COAST SPINE AND SPORTS MEDICINE PLLC
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Dates
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Enumeration Date | 12/27/2024
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Last Update Date | 12/27/2024
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Provider Practice Location Address
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Address Line | 7720 NE VANCOUVER MALL DR STE 120
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City | VANCOUVER
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State | WA
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Zip | 98662-7918
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Country | US
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Telephone | 253-648-1853
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Fax | 425-800-9756
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Provider Business Mailing Address
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Address Line | 8012 112TH STREET CT E STE 120
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City | PUYALLUP
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State | WA
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Zip | 98373-7856
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Country | US
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Telephone | 253-648-1853
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Fax | 425-800-9756
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Authorized Official
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Title or Position | ACCESS MANAGER
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Name | SANDY CLEMENS
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Credential |
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Telephone | 253-648-1853
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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