MEDICARE: COASTAL REHAB LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center		VA

General Provider Information

NPI Number	:	1093749319
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COASTAL REHAB LLC

Provider Business Mailing Address
First Line	:	6751 MADDOX BLVD
Second Line	:
City	:	CHINCOTEAGUE
State	:	VA
Zip	:	23336-2253
Country	:	US
Telephone Number	:	757-336-5134
Fax Number	:

Provider Business Practice Location Address
First Line	:	6751 MADDOX BLVD
Second Line	:
City	:	CHINCOTEAGUE
State	:	VA
Zip	:	23336-2253
Country	:	US
Telephone Number	:	757-336-5134
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	LOUANN MADDOX KING
Credential	:
Telephone Number	:	757-336-5134

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	08/22/2020

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Directions to “COASTAL REHAB LLC ” Practice Location

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