MEDICARE: COAST 2 COAST SPORTS MEDICINE

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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1245007665
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COAST 2 COAST SPORTS MEDICINE

Provider Business Mailing Address
First Line	:	430 OXFORD DR
Second Line	:
City	:	ARCADIA
State	:	CA
Zip	:	91007-2643
Country	:	US
Telephone Number	:	626-241-5134
Fax Number	:

Provider Business Practice Location Address
First Line	:	5300 POWERLINE RD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-3172
Country	:	US
Telephone Number	:	626-241-5134
Fax Number	:

Authorized Official
Title or Position	:	OWNER / PHYSICAL THERAPIST
Name	:	KRISTIAN SALAZAR
Credential	:	PT, DPT
Telephone Number	:	626-241-5134

Provider Enumeration Date	:	12/06/2023
Last Update Date	:	12/06/2023

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Directions to “COAST 2 COAST SPORTS MEDICINE ” Practice Location

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