Provider Demographics
NPI:1346466430
Name:COASTAL REHABILITATION INC
Entity Type:Organization
Organization Name:COASTAL REHABILITATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:MORNINGSTAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-338-2114
Mailing Address - Street 1:101 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-3361
Mailing Address - Country:US
Mailing Address - Phone:252-338-2114
Mailing Address - Fax:252-338-2115
Practice Address - Street 1:503 CYPRESS LN
Practice Address - Street 2:SUITE A
Practice Address - City:MANTEO
Practice Address - State:NC
Practice Address - Zip Code:27954-8016
Practice Address - Country:US
Practice Address - Phone:252-473-9633
Practice Address - Fax:252-473-9635
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COASTAL REHABILITATION INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-17
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
07763OtherBCBS
NC7200037Medicaid
0002WOtherBCBS FACILITY
NC7700350Medicaid
346581Medicare PIN
NC7200037Medicaid
346581Medicare PIN
=========012OtherTRICARE