Provider Demographics
NPI:1326752213
Name:COASTAL PHYSICAL THERAPY AND WELLNESS LLC
Entity Type:Organization
Organization Name:COASTAL PHYSICAL THERAPY AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOERNER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:609-264-1666
Mailing Address - Street 1:3201 W BRIGANTINE AVE
Mailing Address - Street 2:
Mailing Address - City:BRIGANTINE
Mailing Address - State:NJ
Mailing Address - Zip Code:08203-1609
Mailing Address - Country:US
Mailing Address - Phone:609-264-1666
Mailing Address - Fax:
Practice Address - Street 1:3201 W BRIGANTINE AVE
Practice Address - Street 2:
Practice Address - City:BRIGANTINE
Practice Address - State:NJ
Practice Address - Zip Code:08203-1609
Practice Address - Country:US
Practice Address - Phone:609-264-1666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty