Provider Demographics
NPI:1093749319
Name:COASTAL REHAB LLC
Entity Type:Organization
Organization Name:COASTAL REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LOUANN
Authorized Official - Middle Name:MADDOX
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-336-5134
Mailing Address - Street 1:6751 MADDOX BLVD
Mailing Address - Street 2:
Mailing Address - City:CHINCOTEAGUE
Mailing Address - State:VA
Mailing Address - Zip Code:23336-2253
Mailing Address - Country:US
Mailing Address - Phone:757-336-5134
Mailing Address - Fax:
Practice Address - Street 1:6751 MADDOX BLVD
Practice Address - Street 2:
Practice Address - City:CHINCOTEAGUE
Practice Address - State:VA
Practice Address - Zip Code:23336-2253
Practice Address - Country:US
Practice Address - Phone:757-336-5134
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy