Provider Demographics
NPI:1619978012
Name:COASTAL ORTHOPAEDIC DESIGNS
Entity Type:Organization
Organization Name:COASTAL ORTHOPAEDIC DESIGNS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:BERNARD
Authorized Official - Last Name:LANGLAIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-596-5750
Mailing Address - Street 1:12551 INDIAN ROCKS RD
Mailing Address - Street 2:STE 12
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33774-3038
Mailing Address - Country:US
Mailing Address - Phone:272-596-5750
Mailing Address - Fax:727-596-8952
Practice Address - Street 1:12551 INDIAN ROCKS RD
Practice Address - Street 2:STE 12
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33774-3038
Practice Address - Country:US
Practice Address - Phone:272-596-5750
Practice Address - Fax:727-596-8952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLORT41335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier