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General NPI Number Information
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NPI Number | 1811134794
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Entity Type | Organization
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Legal Business Name | COASTAL ORTHOPEDICS & SPORTS MEDICINE OF SOUTHWEST FL, PA
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Dates
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Enumeration Date | 01/14/2009
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 6202 17TH AVE W
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City | BRADENTON
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State | FL
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Zip | 34209-7838
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Country | US
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Telephone | 941-792-1404
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Fax |
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Provider Business Mailing Address
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Address Line | 8000 SR 64 E
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City | BRADENTON
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State | FL
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Zip | 34209
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Country | US
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Telephone | 941-792-1404
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Fax | 941-761-0712
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Authorized Official
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Title or Position | CEO
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Name | MRS. PAIGE LEMAY
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Credential |
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Telephone | 941-792-1404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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