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NPI Code Detail

MEDICARE: COASTLINE THERAPY GROUP, LLC

MEDICARE: COASTLINE THERAPY GROUP, 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
1225100000XPhysical Therapist
22251P0200XPediatric Physical Therapist
3225X00000XOccupational Therapist10745NC
4225X00000XOccupational Therapist
5235Z00000XSpeech-Language Pathologist12318NC
6235Z00000XSpeech-Language Pathologist

General Provider Information

NPI Number : 1730681388
Entity Type Code : Organization
Provider Name (Legal Business Name) : COASTLINE THERAPY GROUP, LLC
Provider Business Mailing Address
First Line : 1468 EASTBOURNE DR
Second Line :
City : WILMINGTON
State : NC
Zip : 28411-8431
Country : US
Telephone Number : 910-461-9168
Fax Number :
Provider Business Practice Location Address
First Line : 3901 WRIGHTSVILLE AVE STE 120
Second Line :
City : WILMINGTON
State : NC
Zip : 28403-6256
Country : US
Telephone Number : 910-679-8385
Fax Number : 910-679-8387
Authorized Official
Title or Position : OWNER, CFO
Name : MRS. KIMBERLY FAYE BAGEANT
Credential :
Telephone Number : 910-461-9168
Provider Enumeration Date : 02/28/2018
Last Update Date : 01/17/2020

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Directions to “COASTLINE THERAPY GROUP, LLC ” Practice Location

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