Provider Demographics
NPI:1518356658
Name:COASTLINE PHYSICAL MEDICINE AND REHABILITATION INC.
Entity Type:Organization
Organization Name:COASTLINE PHYSICAL MEDICINE AND REHABILITATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:MESSBARGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-576-9507
Mailing Address - Street 1:4011 HWY 40
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-4067
Mailing Address - Country:US
Mailing Address - Phone:912-576-9507
Mailing Address - Fax:912-576-9515
Practice Address - Street 1:4011 HWY 40
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-4067
Practice Address - Country:US
Practice Address - Phone:912-576-9507
Practice Address - Fax:912-576-9515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-13
Last Update Date:2015-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA68069208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty