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General NPI Number Information
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NPI Number | 1952673766
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Entity Type | Organization
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Legal Business Name | COASTAL SPINE AND REHAB CENTER LLC
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Dates
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Enumeration Date | 02/09/2012
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Last Update Date | 02/12/2016
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Provider Practice Location Address
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Address Line | 13910 FIVAY RD STE 10
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City | HUDSON
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State | FL
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Zip | 34667-7154
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Country | US
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Telephone | 727-862-3509
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Fax | 727-862-3500
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Provider Business Mailing Address
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Address Line | 13910 FIVAY RD STE. 10
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City | HUDSON
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State | FL
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Zip | 34667-7154
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Country | US
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Telephone | 727-862-3509
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Fax | 727-862-3500
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. THERESA CRANDALL
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Credential | DC
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Telephone | 727-862-3509
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH 10521
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License Number State | FL
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