Provider Demographics
NPI:1568835841
Name:COAST TO COAST PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:COAST TO COAST PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BOLTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-855-9961
Mailing Address - Street 1:5195 HAMPSTED VILLAGE CENTER WAY
Mailing Address - Street 2:SUITE 256
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-8331
Mailing Address - Country:US
Mailing Address - Phone:614-855-9961
Mailing Address - Fax:
Practice Address - Street 1:324 MAIN STREET
Practice Address - Street 2:SUITE 5 & 6
Practice Address - City:OWENTON
Practice Address - State:KY
Practice Address - Zip Code:40359
Practice Address - Country:US
Practice Address - Phone:502-514-2669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy