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General NPI Number Information
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NPI Number | 1881420917
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Entity Type | Organization
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Legal Business Name | COASTAL REHABILITATION LLC
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Dates
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Enumeration Date | 09/13/2024
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Last Update Date | 01/13/2026
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Provider Practice Location Address
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Address Line | 229 SOUTHWOOD DR
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City | PANAMA CITY
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State | FL
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Zip | 32405-4905
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Country | US
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Telephone | 850-481-1117
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Fax | 850-373-4858
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Provider Business Mailing Address
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Address Line | 7113 LAGOON DR
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City | PANAMA CITY BEACH
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State | FL
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Zip | 32408-5509
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Country | US
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Telephone | 850-257-6464
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Fax | 850-248-2469
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Authorized Official
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Title or Position | OWNER/CEO
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Name | JORDAN SCOTT LANCE
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Credential | PT, DPT, CLT, MLD-PP
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Telephone | 504-811-1178
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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