Provider Demographics
NPI:1568589687
Name:COASTAL REHABILITATION INC
Entity Type:Organization
Organization Name:COASTAL REHABILITATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTYN
Authorized Official - Middle Name:J
Authorized Official - Last Name:YAGER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:252-338-2114
Mailing Address - Street 1:101 MEDICAL DRIVE
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 1:115 LOFTIN LANE
Practice Address - Street 2:
Practice Address - City:AHOSKIE
Practice Address - State:NC
Practice Address - Zip Code:27910
Practice Address - Country:US
Practice Address - Phone:252-209-0901
Practice Address - Fax:252-209-0823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
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
NC7200037Medicaid
07763OtherBCBS
0002WOtherBCBS FACILITY
NC7700350Medicaid
0002WOtherBCBS FACILITY
NC7700350Medicaid
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