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General NPI Number Information
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NPI Number | 1942361522
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Entity Type | Organization
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Legal Business Name | COASTAL ORTHOPEDICS AND SPORTS MEDICINE OF SOUTHWEST FLORIDA P.A.
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 02/10/2025
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Provider Practice Location Address
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Address Line | 8000 STATE ROAD 64 E
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City | BRADENTON
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State | FL
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Zip | 34212-7703
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Country | US
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Telephone | 941-792-1404
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Fax | 941-794-1863
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Provider Business Mailing Address
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Address Line | 8000 STATE ROAD 64 E
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City | BRADENTON
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State | FL
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Zip | 34212-7703
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Country | US
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Telephone | 941-792-1404
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Fax | 941-794-1863
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Authorized Official
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Title or Position | CREDENTIALING SURPERVISOR
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Name | NANCY R BORGGREN
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Credential |
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Telephone | 941-782-0102
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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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 | 225000000X
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Taxonomy Name | Orthotic Fitter
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2251H1200X
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Taxonomy Name | Hand Physical Therapist
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License Number |
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License Number State |
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Taxonomy #4
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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 #5
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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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Taxonomy #6
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 225XH1200X
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Taxonomy Name | Hand Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #10
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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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