Provider Demographics
NPI:1083284798
Name:COASTAL CAROLINA PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:COASTAL CAROLINA PHYSICAL THERAPY LLC
Other - Org Name:COASTAL CAROLINA PHYSICAL THERAPY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST/ MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:HUNTER
Authorized Official - Last Name:NADEAU
Authorized Official - Suffix:
Authorized Official - Credentials:PT,DPT
Authorized Official - Phone:207-436-5324
Mailing Address - Street 1:2216 MARINERS FRY
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-5808
Mailing Address - Country:US
Mailing Address - Phone:207-436-5324
Mailing Address - Fax:
Practice Address - Street 1:3014 S MORGANS PT RD STE D
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-7189
Practice Address - Country:US
Practice Address - Phone:843-284-8092
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-26
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty