MEDICARE: COAST TO COAST REHABILITATION INC

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	305R00000X	Preferred Provider Organization	1215200	TX

General Provider Information

NPI Number	:	1194276527
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COAST TO COAST REHABILITATION INC

Provider Business Mailing Address
First Line	:	3650 TIMBERGLEN ROAD APT 3
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75287
Country	:	US
Telephone Number	:	817-797-7934
Fax Number	:

Provider Business Practice Location Address
First Line	:	8553 N BEACH ST
Second Line	:	SUITE 229
City	:	FORT WORTH
State	:	TX
Zip	:	76244-4919
Country	:	US
Telephone Number	:	817-797-7934
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	ABRIAN FLOWERS
Credential	:
Telephone Number	:	817-797-7934

Provider Enumeration Date	:	10/20/2016
Last Update Date	:	10/20/2016

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