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NPI Code Detail

MEDICARE: COASTAL BEND SPINE & SPORT, P.C.

MEDICARE: COASTAL BEND SPINE & SPORT, P.C.
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
1261QP2000XPhysical Therapy Clinic/CenterTX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10022JNOTHERTXBLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number : 1891841169
Entity Type Code : Organization
Provider Name (Legal Business Name) : COASTAL BEND SPINE & SPORT, P.C.
Provider Business Mailing Address
First Line : 1301 E HOUSTON ST
Second Line :
City : BEEVILLE
State : TX
Zip : 78102-5309
Country : US
Telephone Number : 361-362-1700
Fax Number : 361-362-1369
Provider Business Practice Location Address
First Line : 1301 E HOUSTON ST
Second Line :
City : BEEVILLE
State : TX
Zip : 78102-5309
Country : US
Telephone Number : 361-362-1700
Fax Number : 361-362-1369
Authorized Official
Title or Position : PRESIDENT
Name : DARRYL L MARTIN
Credential : PT
Telephone Number : 361-362-1700
Provider Enumeration Date : 01/26/2007
Last Update Date : 01/23/2008

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1629408836 — COURTNEY THOMSON PT
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1134514250 — CARLOS VASQUEZ PT
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1457443558 — MRS. TERALEA D JONES PA-C
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78102
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Directions to “COASTAL BEND SPINE & SPORT, P.C. ” Practice Location

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