Provider Demographics
NPI:1346539053
Name:ALL COAST THERAPY SERVICES OUTPATIENT INC
Entity Type:Organization
Organization Name:ALL COAST THERAPY SERVICES OUTPATIENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HORSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:352-326-4014
Mailing Address - Street 1:PO BOX 490210
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34749-0210
Mailing Address - Country:US
Mailing Address - Phone:352-326-4014
Mailing Address - Fax:352-326-4126
Practice Address - Street 1:740 W BURLEIGH BLVD
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-2302
Practice Address - Country:US
Practice Address - Phone:352-742-1016
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-04
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRS4OtherBLUE CROSS
FLRS4OtherBLUE CROSS