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General NPI Number Information
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NPI Number | 1972745743
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Entity Type | Organization
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Legal Business Name | COASTAL ORTHOPEDIC CENTER
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Dates
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Enumeration Date | 03/25/2009
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Last Update Date | 03/25/2009
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Provider Practice Location Address
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Address Line | 3954 US HIGHWAY 27 S
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City | SEBRING
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State | FL
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Zip | 33870-5511
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Country | US
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Telephone | 772-871-9200
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Fax | 772-336-4040
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Provider Business Mailing Address
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Address Line | 510 SW PORT ST LUCIE BLVD
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City | PORT ST LUCIE
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State | FL
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Zip | 34953-1943
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Country | US
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Telephone | 772-871-9200
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Fax | 772-336-4040
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOSEPH PERRETTA
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Credential | CP
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Telephone | 772-871-9200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | PRO 84
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License Number State | FL
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