Provider Demographics
NPI:1447202072
Name:TRADE WINDS HEALTH, SWIM, & TAN CLUB, INC.
Entity Type:Organization
Organization Name:TRADE WINDS HEALTH, SWIM, & TAN CLUB, INC.
Other - Org Name:COASTAL PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AIMEE
Authorized Official - Middle Name:
Authorized Official - Last Name:LIBERTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-542-9081
Mailing Address - Street 1:2 PARK DR
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04841-3449
Mailing Address - Country:US
Mailing Address - Phone:207-596-6889
Mailing Address - Fax:207-596-2105
Practice Address - Street 1:2 PARK DR
Practice Address - Street 2:
Practice Address - City:ROCKLAND
Practice Address - State:ME
Practice Address - Zip Code:04841-3449
Practice Address - Country:US
Practice Address - Phone:207-596-6889
Practice Address - Fax:207-596-2105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty