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General NPI Number Information
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NPI Number | 1891560215
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Entity Type | Organization
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Legal Business Name | COASTAL ORTHOPEDIC ADVANTAGE LLC
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Dates
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Enumeration Date | 11/15/2023
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Last Update Date | 11/15/2023
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Provider Practice Location Address
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Address Line | 1010 PENINSULA RD
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City | TARPON SPRINGS
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State | FL
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Zip | 34689-2940
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Country | US
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Telephone | 727-487-2050
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Fax |
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Provider Business Mailing Address
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Address Line | 1010 PENINSULA RD
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City | TARPON SPRINGS
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State | FL
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Zip | 34689-2940
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Country | US
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Telephone | 724-316-2269
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | BRYAN STERLING
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Credential | PT, DPT, OCS, CSCS
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Telephone | 724-316-2269
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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